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

• Published in: International journal of radiation oncology, biology, physics Vol. 98; no. 4; pp. 748 - 757
• Main Authors: Fang, Penny, MD, He, Weiguo, PhD, Gomez, Daniel R., MD, Hoffman, Karen E., MD, MPH, Smith, Benjamin D., MD, Giordano, Sharon H., MD, MPH, Jagsi, Reshma, MD, DPhil, Smith, Grace L., MD, PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2017
• Subjects: 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; Hematology, Oncology and Palliative Medicine; 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; Radiology; 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
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2017.01.228

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.