TY - JOUR
T1 - Results and impact of routine assessment of comorbidity in elderly patients with non-small-cell lung cancer aged > 80 years
AU - Breen, David
AU - Barlési, Fabrice
AU - Zemerli, Myriam
AU - Doddoli, Christophe
AU - Torre, Jean Philippe
AU - Thomas, Pascal
AU - Astoul, Philippe
N1 - Funding Information:
David Breen, MD, is the recipient of a European Respiratory Society/European Lung Foundation Fellowship (#21).
PY - 2007/1/1
Y1 - 2007/1/1
N2 - BACKGROUND: Elderly patients now represent a bigger proportion of patients with non-small-cell lung cancer (NSCLC). However, data from clinical trials are limited for this age group, and the elderly are often excluded from optimal treatment for several reasons, including comorbidity. PATIENTS AND METHODS: We reviewed a 10-year experience on proven patients with NSCLC aged > 80 years; comorbidity was assessed using the Charlson Comorbidity index (CCI). The main objective was the impact of comorbidity on survival outcome. RESULTS: Of 109 managed patients aged > 80 years, 74 patients had a proven diagnosis of NSCLC. Performance status was < 2 in 58 patients and TNM classification of malignant tumors was I-II, IIIA-IIIB, and IV in 18, 27, and 29 patients, respectively. Comorbidity was present for 49 patients. Charlson Comorbidity Index ranged from 4 to 12 with 31 patients having a CCI ≥ 6. Sixteen patients received supportive care only, whereas 23 patients were operated on, 12 received radiation therapy, and 23 had chemotherapy. Eight grade 3/4 toxicities were reported (3 patients discontinued treatment). Multivariate analysis demonstrated a significant increase in the risk of death for patients with a poor Eastern Cooperative Oncology Group performance status (hazard ratio, 2.64; 95% confidence interval, 1.3-5.36; P = 0.007) and an advanced TNM stage (hazard ratio, 3.31; 95% confidence interval, 1.99-5.5; P < 0.00001). Although statistic significance was not reached, a difference in overall survival was shown between patients with a CCI < 6 and CCI ≥ 6 (12.2 months vs. 8.2 months; P = 0.08). CONCLUSION: These results support a role for the CCI as a routine means to assess comorbidity, because patients with fewer comorbidities tolerate and derive survival benefit of optimal NSCLC management. These findings must be confirmed in prospective studies.
AB - BACKGROUND: Elderly patients now represent a bigger proportion of patients with non-small-cell lung cancer (NSCLC). However, data from clinical trials are limited for this age group, and the elderly are often excluded from optimal treatment for several reasons, including comorbidity. PATIENTS AND METHODS: We reviewed a 10-year experience on proven patients with NSCLC aged > 80 years; comorbidity was assessed using the Charlson Comorbidity index (CCI). The main objective was the impact of comorbidity on survival outcome. RESULTS: Of 109 managed patients aged > 80 years, 74 patients had a proven diagnosis of NSCLC. Performance status was < 2 in 58 patients and TNM classification of malignant tumors was I-II, IIIA-IIIB, and IV in 18, 27, and 29 patients, respectively. Comorbidity was present for 49 patients. Charlson Comorbidity Index ranged from 4 to 12 with 31 patients having a CCI ≥ 6. Sixteen patients received supportive care only, whereas 23 patients were operated on, 12 received radiation therapy, and 23 had chemotherapy. Eight grade 3/4 toxicities were reported (3 patients discontinued treatment). Multivariate analysis demonstrated a significant increase in the risk of death for patients with a poor Eastern Cooperative Oncology Group performance status (hazard ratio, 2.64; 95% confidence interval, 1.3-5.36; P = 0.007) and an advanced TNM stage (hazard ratio, 3.31; 95% confidence interval, 1.99-5.5; P < 0.00001). Although statistic significance was not reached, a difference in overall survival was shown between patients with a CCI < 6 and CCI ≥ 6 (12.2 months vs. 8.2 months; P = 0.08). CONCLUSION: These results support a role for the CCI as a routine means to assess comorbidity, because patients with fewer comorbidities tolerate and derive survival benefit of optimal NSCLC management. These findings must be confirmed in prospective studies.
KW - Charlson comorbidity index
KW - Hazard ratio
UR - http://www.scopus.com/inward/record.url?scp=34248207626&partnerID=8YFLogxK
U2 - 10.3816/CLC.2007.n.013
DO - 10.3816/CLC.2007.n.013
M3 - Article
C2 - 17562233
AN - SCOPUS:34248207626
SN - 1525-7304
VL - 8
SP - 331
EP - 334
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
IS - 5
ER -