Chemotherapy dose delivery in elderly patients with lung and colon cancer; a single institution study

Abstract

8261 Background: Chemotherapy dose delivery in the elderly is a challenge. Often, elderly patients undergo surgery but not all receive adjuvant or palliative chemotherapy despite proven benefit of these regimens to improve survival. The purpose of our study was to analyze the practice patterns of chemotherapy dose ordering and delivery in patients with ages 70 years and above who were diagnosed with lung or colorectal cancer (CRC) at our institution. Methods: A retrospective review of chemotherapy charts was performed for patients identified over the age of 70 years with a diagnosis of CRC and lung cancer at our institution from 1998–2002. The Institutional Review Board approved the study. We studied the chemotherapy regimens, dose modifications and concurrent use of radiation therapy in lung cancer and CRC. Frequency of growth factor support utilization was identified. Results: 36 patients were identified who received chemotherapy (n=21 lung ca; n=15 CRC). Median age of all patients was 75 yrs (range 70–85 years); M: F 6:15 (lung ca), 7:8 (CRC). Performance status of all pts. 0–2 (ECOG). Stage distribution: lung ca (IIIA n=5; IIIB n=9, IV n=5, small cell lung ca n=2). CRC (high risk II n=8, III n=5, IV n=2). 12 of 21 pts.treated for lung ca received concurrent chemotherapy and radiation therapy. All 12 patients received standard regimens but only 3/12 (25%) received standard doses of carboplatin and paclitaxel. 4/12 (33%) were treated with a single drug, carboplatin or paclitaxel with radiation. 8/14 (57%) pts completed 5 weeks or more of planned radiation treatment. Analysis of CRC pts: 7/15(46 %) received a standard regimen (5FU/ Leucovorin). Doses were initially reduced by 10% in all. 2 pts required further dose reductions of 5-FU and Leucovorin secondary to diarrhea. 11/36 (30%) pts required G-CSF supplementation. 23/36 pts. (64%) required erythropoietin support. Conclusions: Elderly patients require significant dose reductions and modifications to tolerate chemotherapy +/- XRT safely and are frequently unable to complete proposed treatments. The impact of established treatment regimens on survival in elderly patients needs to be further investigated No significant financial relationships to disclose.