Effect of age on treatment and survival among patients with non-small cell lung cancer

Abstract

18504 Background: Lung cancer is a disease of the elderly. Yet older patients are underrepresented in clinical trials resulting in scanty efficacy data. We sought to assess the relationship between age, treatment and overall survival in a cohort of patients with non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective cohort study of patients with consecutively diagnosed NSCLC between 1999 and 2003 at the Boston Veterans Administration Medical Center (BVAMC). All patients with a biopsy proven NSCLC were included. Patients diagnosed at autopsy were excluded. Data sources included the BVAMC tumor registry and medical records. Deaths were ascertained from the Social Security Administration and VA databases. All patients were right censored at death from any cause or at 12/31/2004, whichever came first. Our primary endpoints were 1) receipt of surgery; 2) receipt of chemotherapy; and 3) three-year overall survival. Our independent variable was age, operationalized as 70 years and older versus less than 70 years. We used logistic regression analysis to assess the relationship between age and treatment and Kaplan-Meier curves and Cox proportional hazards modeling to determine the effect of age on survival. Results: We studied 410 patients. 211 (51%) of the cohort were ≥70 years and 199 (49%) were <70 years. Among those with localized disease (stages I and II) there was no significant difference in the odds of receiving surgery between the two age categories, (OR = 1.54, 95% CI, 0.72, 3.28). Among those with non-localized disease (stages III and IV) those who were ≥ 70 years were less likely to receive chemotherapy (OR = 0.46, 95% CI, 0.27, 0.79). There were 308 deaths from all causes: 167 in the ≥ 70 year group and 141 in the <70 year group. The three-year overall survival was 20.4% (95% CI, 14.5%, 26.3%) and 32.7% (95% CI, 25.3%, 39.5%) for the ≥70 and <70 year groups, respectively. The adjusted hazard ratio was 0.72 (95% CI, 0.57, 0.92), P = 0.03 by the log rank test in favor of those less than 70 years. Other significant predictors of overall survival included stage at diagnosis and treatment. Comorbidity was not a significant predictor of overall survival. Conclusion: The poorer survival outcome among older NSCLC patients at the BVAMC may be improved by more aggressive treatment with chemotherapy. No significant financial relationships to disclose.