Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer.
OBJECTIVE
Platinum-doublet chemotherapy regimens have been shown to extend survival in fit patients with advanced non-small-cell lung cancer (AdvNSCLC). This study extends recent population-based analyses focusing on treatment and survival benefit from use of platinum-doublet therapy, and addressing the role of performance status (PS).


METHODS
Patients >or= 66 years with AdvNSCLC incident from 1997 to 2002 were identified in SEER-Medicare. Multivariate models examined tumor and patient characteristics associated with receipt of any chemotherapy and receipt of platinum-doublet compared with single-agent therapy. Nonparametric models estimated treatment effects on survival. Models controlled for patient characteristics, including a novel method to use claims-based indicators to characterize PS. Propensity score analysis adjusted for confounding.


RESULTS
Of the 21,285 patients, 25.8% received first-line chemotherapy. Multivariate analyses indicate lower use of any chemotherapy and platinum-based doublet regimens with increasing age, comorbidity, and poor PS. Receipt of any chemotherapy was associated with reduction in the adjusted hazard of death (0.558; 95% CI, 0.547 to 0.569) and an increase in adjusted 1-year survival from 11.6% (95% CI, 11.1 to 12.0) to 27.0% (95% CI, 26.4 to 27.6). Platinum-doublet receipt increased adjusted 1-year survival over single agents, from 19.4% (95% CI, 18.3 to 20.4) to 30.1% (95% CI, 28.9 to 31.4).


CONCLUSIONS
Most elderly patients with AdvNSCLC do not receive chemotherapy, yet there are clear survival benefits, even with controls for age, comorbidity, and PS. The benefit of platinum-based doublet regimens is greater than single-agent chemotherapy. Claims-based proxy indicators of poor PS were independent predictors of treatment and merit further exploration.
Davidoff
Amy J
AJ
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland Baltimore, 220 Arch St, 12th Floor, Room 214, Baltimore, MD 21201, USA. adavidof@rx.umaryland.edu
Tang
Mei
M
Seal
Brian
B
Edelman
Martin J
MJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D017671:Platinum Compounds / Q000008:administration & dosage; D011159:Population Surveillance; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D017671:Platinum Compounds