Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):748-757. doi: 10.1016/j.ijrobp.2017.01.228. Epub 2017 Feb 1.

Abstract

Purpose: To examine the frequency of guideline-concordant cancer care in elderly patients, including "older" elderly (age ≥80 years).

Methods and materials: Using the Surveillance, Epidemiology and End Results-Medicare dataset in patients aged ≥66 years diagnosed with nonmetastatic breast cancer (n=55,094), non-small cell lung (NSCLC) (n=36,203), or prostate cancer (n=86,544) from 2006 to 2011, chemotherapy, surgery, and radiation (RT) treatments were identified using claims. Pearson χ2 tested associations between age and guideline concordance.

Results: Older patients were less likely to receive guideline-concordant curative treatment: in stage III breast cancer, receipt of postmastectomy RT (70%, 46%, and 21% in patients aged 66-79, 80-89, and ≥90 years, respectively; P<.0001); in stage I NSCLC, RT or surgery (89%, 80%, and 64% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage III NSCLC, RT or surgery plus chemotherapy (79%, 58%, and 27% in age 66-79, 80-89, and ≥90 years; P<.0001); and in intermediate/high-risk prostate cancer, RT or prostatectomy (projected life expectancy >10 years: 85% and 82% in age 66-69 and 70-75 years; and ≤10 years: 70%, 42%, and 9% in age 76-79, 80-89, and ≥90 years; P<.0001). However, older patients were more likely to receive guideline-concordant de-intensified treatment: in stage I to II node-negative breast cancer, hypofractionated postlumpectomy RT (9%, 16%, and 23% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I estrogen receptor-positive breast cancer, observation after lumpectomy (12%, 42%, and 84% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I NSCLC, stereotactic body RT instead of surgery (7%, 16%, and 25% in age 66-79, 80-89, and ≥90 years; P<.0001); and in lower-risk prostate cancer, no active treatment (25%, 54%, and 68% in age 66-79, 80-89, and ≥90 years; P<.0001).

Conclusion: Actual treatment of older elderly cancer patients frequently diverged from guidelines, especially in curative treatment of advanced disease. Results suggest a need for better metrics than existing guidelines alone to evaluate quality and appropriateness of care in this population.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors*
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Benchmarking
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Chi-Square Distribution
  • Combined Modality Therapy / standards
  • Combined Modality Therapy / statistics & numerical data
  • Female
  • Guideline Adherence / standards*
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Life Expectancy
  • Logistic Models
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Male
  • Mastectomy
  • Medicare
  • Pneumonectomy / standards
  • Pneumonectomy / statistics & numerical data
  • Prostatectomy / standards
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data
  • Radiotherapy / standards
  • Radiotherapy / statistics & numerical data
  • Radiotherapy Dosage / standards
  • SEER Program
  • Severity of Illness Index
  • United States
  • Watchful Waiting / standards
  • Watchful Waiting / statistics & numerical data

Substances

  • Antineoplastic Agents