Assessment of cancer care in Indian elderly cancer patients: A single center study

Abstract

Background and purpose: This prospective study aimed to assess the profiles of elderly cancer patient to optimize cancer care in Indian setup. The profiles have been compared with that of younger patients in terms of epidemiological, clinical data, co‑morbidity, treatment, toxicity, clinical outcome, and survival pattern. Materials and Methods: The study comprised cancer patients attending radiotherapy outdoor (November 2005 to June 2006). There were 104 patients of age ≥60 years (elderly group) and 121 patients of 45-59 years (younger group). Results: Elderly group had median age 65 years (60-88 years) with M:F = 1:1. The younger group had median age 50 years (45-59 years) with M:F = 1:2. Elderly had higher proportion of gastrointestinal and genito‑urinary tract malignancies. Younger group had higher proportion of breast, lymphoma, and brain tumor. 13% had co‑morbidity, 50% received treatment, 27% were treated with radiotherapy with or without surgery, and two‑third of these cases belong to elderly group. Majority tolerated treatment well. 10% had significant grade of toxicity. 57% of elderly patients did not accept and one‑fourth of all cases did not complete the prescribed treatment. 88% cases were responders of which 70% showed complete response. There were no differences between two groups. At 12 months 35% of treated patients came for follow‑up. At first 12 months, 60-70% were alive without disease. Conclusion: There were differences between two groups in terms of performance status, treatment acceptance, and treatment modality prescribed. Elderly patients deserve same opportunity as younger patients for treatment and survival options from the oncologist.

Key words

Cancer care optimization - comparison of profiles - Indian elderly and younger cancer patients - geriatric - elder

Publication History

Article published online:
31 December 2020

• References

• 1 Aapro MS, Köhne CH, Cohen JH, Extermann M. Never too old? Age should not be a barrier to enrollment in cancer clinical trials. Oncologist 2005;10:198-4.
• 2 Agarwal SP, Rao YN, Gupta S. Fifty years of cancer control in India. 1^st ed. National Cancer Control Program (NCCP); 2002. p. 41-7.
• 3 Susan BR, Muss BH. Adjuvant chemotherapy in the elderly: Whom to treat, what regimen? Oncologist 2006;11:234-42.
• 4 Carol A, Selby TR, Siu LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 2005;23:3112-24.
• 5 Carol T, Pond GR, Peloza B, Kok J, Naidoo K. Analysis of treatment practices for elderly cancer patients in Ontario, Canada. J Clin Oncol 2005;23:3802-10.
• 6 Dinshaw KA, Nene BM, Prabhakaran PS, Prasad AE. Bangalore population based cancer registry, Bangalore, Kidwai Memorial Institute of Oncology, Bangalore. Individual Registry Data: 1990-1996.
• 7 Extermann M, Aparo M. Assessment of older cancer patients. Hematol Oncol Clin North Am 2000;14:63-77.
• 8 Hilpert F, du Bois A, Greimel ER, Hedderich J, Krause G, Venhoff L, et al. Feasibility, toxicity and quality of life of first-line chemotherapy with platinum/paclitaxel in elderly patients aged 70 years with advanced ovarian cancer-a study by the AGO OVAR Germany. Ann Oncol 2007;18:282-7.
• 9 Guralink JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol 1996;6:376-80.
• 10 Fried LP, Roche BK, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women: The Women Health And Aging Study. J Clin Epedemiol 1999;52:27-37.
• 11 Karen WL, Joseph LY, Pho LP, Zee B. Enrollment of older patients in cancer treatment trials in Canada: Why is age a barrier? J Clin Oncol 2003;21:1618-23.
• 12 Kumar A, Soares HP, Balducci L. Treatment tolerance and efficacy in elderly oncology: A systematic review of phase III randomized trials conducted by five National Cancer Institute-Sponsored Cooperative Groups. J Clin Oncol 2007;25:1272-6.
• 13 Monfardini S, Sorio R, Boes GH, Kaye S, Serraino D. Entry and evaluation of elderly patients in European Organization for Research and Treatment of Cancer (EORTC) new-drug-development studies. Cancer 1995;76:333-8.
• 14 Monfardini S. Elderly oncology: A new subspecialty? J Clin Oncol 2004;22:4655.
• 15 Hyman BM, Woolf S, Berry D, Cirrincione C, Raymond B. For the cancer and leukemia group B: Adjuvant Chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 2005;293:1073-81.
• 16 Nandakumar A. National Cancer Registry Programme (NCRP), Indian Council of Medical Research. August 2001.
• 17 O′ConnellJ B, Maggard MA, Ko CY. Cancer-directed surgery for localized disease: Decreased use in the elderly. Ann Surg Oncol 2004;11:962-9.
• 18 Okamoto I, Moriyama E, Fujii S, Kishi H, Nomura M, Goto E, et al. Phase II study of carboplatin-Paclitaxel combination chemotherapy in elderly patients with advanced non-small cell lung cancer. Jpn J Clin Oncol 2005;35:188-94.
• 19 Makrantonakis PD, Galani E, Harper GP. Non-small cell lung cancer in the elderly. Oncologist 2004;9:556-60.
• 20 Rama R. Statistical Assistant, PBCR. Population based cancer registry, Chennai Cancer Institute (wia), Adyar, Chennai: Individual Registry Data: 1990-1996.
• 21 Repetto L, Mammoliti SC. Life expectancy, comorbidity and quality of life: The treatment equation in the older cancer patients. Crit Rev Oncol Hematol 2001;37:147-52.
• 22 Goldberg RM, Fisch TI, Bleiberg H, De Gramont A, Tournigand C. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol 2006;24:4085-91.
• 23 Yancik R. Cancer burden in the aged: An epidemiologic and demographic overview. Cancer 1997;80:1273-83.
• 24 SEER Cancer Statistics Review, 1975-2003.
• 25 Silliman RA, Guadagnoli E, Weitberg AB, Mor V. Age as a predictor of diagnostic and initial treatment intensity in newly diagnosed breast cancer patients. J Gerontol March1989;44:M46-50.
• 26 Smith BD, Haffty BG, Hurria A, Galusha DH, Gross CP. Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol 2006;24:4901-7.
• 27 Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: A 7-year experience by the US Food and Drug Administration. J Clin Oncol 2004;22:4626-31.
• 28 Turner NJ, Haward RA, Mulley GP, Selby PJ. Cancer in old age: Is it inadequately investigated and treated? BMJ 1999;319:309-12.
• 29 WHO, Geneva. National cancer control programmes, policies and managerial guidelines. 2^nd ed. Geneva: World Health Organization; 2002.
• 30 Yancik R, Ries LA. Cancer in older persons: An international issue in an aging world. Semin Oncol 2004;31:128-36.
• 31 Yancik R, Ries LA. Aging and cancer in America, demographic and epidemiologic perspectives Hematol Oncol Clin North Am 2000;14:17-23.
• 32 Yancik R, Ganz PA, Varricchio CG, Conley B. Perspective on comorbidity and cancer in older patients: Approaches to expand the knowledge base. J Clin Oncol 2001;19:1147-51.
• 33 Lichtman MS. Guidelines for the treatment of elderly cancer patients. Cancer Control 2003;10:445-53.
• 34 Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885-92.
• 35 Perpetuo MD, Valdivieso M, Hebrum LK. Natural history, study of gallbladder cancer: A review of 36 years experience at MD Anderson Hospital and Tumor Institute. Cancer 1978;42:330.