The influence of age and comorbidity on receiving radiotherapy as part of primary treatment for cancer in South Netherlands, 1995 to 2002

• Published in: Cancer Vol. 106; no. 12; pp. 2734 - 2742
• Main Authors: Vulto, Ans J. C. M., Lemmens, Valery E. P. P., Louwman, Marieke W. J., Janssen‐Heijnen, Maryska L. G., Poortmans, Philip H. P., Lybeert, Marnix L. M., Coebergh, Jan Willem W.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.06.2006; Wiley-Liss
• Subjects: Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Breast Neoplasms - radiotherapy; Combined Modality Therapy; Comorbidity; elderly; Female; Humans; Lung Neoplasms - radiotherapy; Lymphoma, Non-Hodgkin - radiotherapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; Netherlands; population‐based; Prevalence; Prostatic Neoplasms - radiotherapy; radiotherapy; Radiotherapy - utilization; Rectal Neoplasms - radiotherapy; referral rates; Regression Analysis; Tumors; Netherlands; Europe; Human; Concomitant disease; Cancerology; Treatment; comorbidity; Primary; referral rates; Malignant tumor; Radiotherapy; Elderly; Age; population-based
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21934

BACKGROUND The objective of this study was to study the influence of age and comorbidity on receiving radiotherapy (RT) in primary treatment of cancer. METHODS In a population‐based setting, the authors calculated the proportion of irradiated patients within 6 months after they received a diagnosis of lung, rectal, breast, or prostate cancer or non‐Hodgkin lymphoma (n = 33,369 patients) according to age and comorbidity between 1995 and 2002. Logistic regression analysis was used to adjust for age, comorbidity, gender, and stage. RESULTS Patients with localized nonsmall cell lung cancer (NSCLC) ages 65 years to ≥80 years or with comorbid conditions received RT alone significantly more often compared with younger patients (ages 65‐79 years: odds ratio [OR], 3.4; age ≥80: OR, 12.0) and patients without comorbidities (1 comorbid condition: OR, 2.1; ≥2 comorbid conditions: OR, 2.4). This also applied to patients with nonlocalized NSCLC ages 65 years to 79 years compared with younger patients (OR, 1.4). RT was administered significantly less often to elderly patients with resected rectal cancers (ages 65‐79 years: OR, 0.7; age ≥80 years: OR, 0.4), patients age ≥80 years with breast cancer after undergoing conserving surgery (OR, 0.1), and patients age ≥80 years with clinical T1‐T3,N0,M0 prostate cancer age (OR, 0.1) compared with younger patients. Patients with breast cancer who underwent breast‐conserving surgery received RT significantly less often in the presence of comorbidities (1 comorbid condition: OR, 0.6; ≥2 comorbid conditions: OR, 0.4). Older patients with aggressive non‐Hodgkin lymphoma received only RT as treatment significantly more often compared with younger patients (OR, 3.4). CONCLUSIONS Comorbidity and age did have influence over whether patients received RT, although, for most tumor types, age appeared to be a stronger predicting factor. Under treatment was observed among patients with breast cancer and rectal cancer. Cancer 2006. © 2006 American Cancer Society. In a population‐based setting, the authors studied the influence of age and comorbidity on the administration of radiotherapy (RT) among 33,369 patients who were diagnosed with cancer between 1995 and 2002. In general, elderly patients and patients with comorbid conditions were treated less aggressively compared with patients who received standard treatment. Patients with lung cancer or non‐Hodgkin lymphoma more often received RT alone instead of surgery or RT combined with chemotherapy, and patients with rectal cancer or breast cancer often had adjuvant RT withheld before or after surgery.