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A recent article in the Journal of Clinical Oncology reports that chemotherapy prolongs survival among older people diagnosed with non-small cell lung cancer (NSCLC), although it may be underutilized in people with advanced stages of NSCLC.

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe. NSCLC is the most common type of lung cancer and is a malignancy that arises from the tissues of the lung. Under most circumstances, NSCLC is not curable. Current treatments include surgery, chemotherapy and radiation. Chemotherapy with platinum-based chemotherapy is frequently used to treat NSCLC; however, platinum-based chemotherapy is associated with significant side effects, making treatment difficult for elderly or physically unfit patients. In this recent trial, researchers sought to determine the chemotherapy treatment patterns among the elderly.

Researchers from the Fred Hutchinson Cancer Research Center recruited 14,875 patients with locally advanced or metastatic NSCLC. These patients were then categorized based on their previous treatment with chemotherapy during the first 3 months after diagnosis. Extensive analysis was then used to compare survival and calculate medical costs for each group. Researchers were careful to make these comparisons after age, sex, race, other existing diseases, initial stage of the disease, and prior radiation were taken into consideration.

Results of the study found that of the 14,875 patients, 7,411(49.8%) were diagnosed with stage III disease and 7,464 (50.2%) had stage IV disease at the time of diagnosis. Treatment options included chemotherapy (31%), surgery (8%), and radiation (53%). Further analysis revealed that people over the age of 75, females, African Americans, and those patients with more than one other chronic illness were significantly less likely to receive chemotherapy. In addition, overall survival outcomes were significantly compromised for those patients who did not receive chemotherapy with a platinum-based drug. Medical costs were determined to be the highest for those patients who received a platinum-based chemotherapy regimen along with a taxane-based chemotherapy, exceeding the cost of other chemotherapy regimens by $10,000 per patient.

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Researchers concluded that chemotherapy among older persons prolongs survival, although it may be underutilized in patients diagnosed with advanced stages of NSCLC. Variations among the use of chemotherapy among minorities and regional variations warrant further study.

Reference: Ramsey S, Howlader N, Etzioni R et al. Chemotherapy Use, Outcomes and Costs for Older Persons with Advanced Non-Small Cell Lung Cancer: Evidence From Surveillance, Epidemiology and End Results-Medicare. Journal of Clinical Oncology. 2004; 24: 4971-4978.

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