State of health, not age, should decide treatment for cancer

Researchers recommend considering other illnesses, as well as age, before starting treatment

In a study of patients 65 and older with non-small-cell lung cancer (NSCLC), younger patients were more likely to receive treatment than older patients, regardless of overall health and prognosis.

The study of more than 20,000 patients, led by a team of physicians at the San Francisco VA Medical Center and the University of California, San Francisco, found that, for all stages of cancer, treatment rates decreased more in association with advancing age than with the worsening of other illnesses.

Patients between the ages of 65 to 74 who were severely ill from other illnesses, and thus less likely to benefit and more likely to be harmed from cancer treatment, received treatment at roughly the same rate as patients in the same age range with no comorbidities. They were more likely to receive treatment than patients between 75 and 84 with no comorbidities and much better prognoses.

"It's clear that as human beings and physicians, we fixate on age in deciding whether to pursue cancer treatments, including lung cancer treatments," said lead author Sunny Wang, MD, an SFVAMC physician and an assistant clinical professor of medicine at UCSF. "Instead, we should be looking at our patients' overall state of health."

The study was based on an analysis of the electronic health records of 20,511 patients age 65 and older who were in the VA Central Cancer Registry from 2003 to 2008. It was published on May 1 in the Journal of Clinical Oncology.

NSCLC is the most common form of lung cancer. The authors cited previous research indicating that older NSCLC patients who are otherwise healthy can benefit from treatment, while those with comorbidities are more vulnerable to the toxicity of cancer treatments and less likely to complete a course of treatment. Significant comorbidity can also limit life expectancy, thus undermining the potential survival benefit of treatment.

"The message here is, don't base cancer treatment strictly on age," said Wang. "Don't write off an otherwise healthy 75 year old, and don't automatically decide to treat a really ill 65 year old without carefully assessing the risks and benefits for that patient."

Currently, Wang and her fellow researchers are conducting a follow-up study looking at survival outcomes among the same cohort of patients.