Benefits of chemotherapy for elderly patients with lung cancer must be weighed against risk of long-term toxicities
A new, population-based study of the toxic impact of chemotherapy on elderly patients with nonsmall cell lung cancer (NSCLC) identifies a number of common short-term and long-term toxicities associated with treatment with different chemotherapy regimens. The researchers studied 14 different chemotherapy regimens and 50 toxicity-related problems. Overall, patients who received chemotherapy had 4.4 times the incidence of long-term toxicity than patients not given chemotherapy. Female patients, those with localized disease, and those with fewer medical conditions were more likely to have long-term toxicity.
The commonest short-term toxicities, which developed within 3 months or less of treatment, included: acute anemia (20.0 to 35.9 percent incidence); nausea (20.1 to 60 percent); and neutropenia, a decrease in an important type of white blood cell, (9.2 to 22.5 percent). For long-term toxicities, which developed beyond 3 months of treatment, the most common included: acute anemia (30.7 to 37.6 percent incidence); dehydration (24.9 to 33.6 percent); respiratory failure (26.3 to 40.8 percent); pulmonary fibrosis, or lung scarring, (25.0 to 33.3 percent); neutropenia (17.0 to 33.3 percent); nausea (16.0 to 25.6); and fever (13.3 to 20.0 percent).
The study drew on the National Cancer Institute's Surveillance, Epidemiology, and End Results Program-Medicare linked database. The researchers looked at 41,361 elderly men and 30,804 elderly women diagnosed with NSCLC between the beginning of 1991 and the end of 2002. The findings may help physicians and patients weigh the survival benefit from particular chemotherapy agents against the risk of difficult-to-manage long-term toxicity, the researchers suggest. Their study was funded in part by the Agency for Healthcare Research and Quality (HS16743).
More details are in "Chemotherapy-associated toxicity in a large cohort of elderly patients with non-small cell lung cancer," by Dale Hardy, Ph.D., Janice N. Cormier, M.D., M.P.H., Yan Xing, M.D., Ph.D., and others in the January 2010 Journal of Thoracic Oncology 5(1), pp. 90-98.
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