title: Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy.
abstract: OBJECTIVE
  To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other patients during treatment.
  
  
  METHODS
  Patients enrolled onto a phase III trial comparing pemetrexed/carboplatin with gemcitabine/carboplatin as first-line therapy of stage IIIB/IV NSCLC were analysed. Eligible patients had performance status 0-2 and adequate kidney/liver/bone-marrow function. Comorbidity was assessed from hospital medical records using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Toxicity was graded using the CTCAE v3.0 and the patients reported HRQoL on the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30/LC13.
  
  
  RESULTS
  Data from 402 of the 436 of the patients enrolled onto the phase III trial were analysed. The patients with severe comorbidity had similar survival as other patients (6.9 versus 8.1months; p=.34), similar frequency of neutropenia (48% versus 42%; p=.16), but experienced more neutropenic fevers (12% versus 5%; p=.012) and deaths from neutropenic infections (3% versus 0%; p=.027). They had more thrombocytopenia (46% versus 36%; p=.03), but not more thrombocytopenic bleedings (3% versus 4%; p=.65). In general, the patients with severe comorbidity reported poorer HRQoL, but not significantly more deterioration of HRQoL.
  
  
  CONCLUSIONS
  The results from our study suggest that patients with advanced NSCLC who have severe co-existing disorders benefit from and tolerate platinum-doublet chemotherapy as well as other patients. They do, however, appear to have a higher risk of acquiring infections when neutropenic.
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway. bjorn.h.gronberg@gmail.com
authors.forename: Bjørn H
authors.initials: BH
authors.lastname: Grønberg
authors.forename: Stein
authors.initials: S
authors.lastname: Sundstrøm
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.forename: Oystein
authors.initials: O
authors.lastname: Fløtten
authors.forename: Tore
authors.initials: T
authors.lastname: Amundsen
authors.forename: Harald H
authors.initials: HH
authors.lastname: Hjelde
authors.forename: Christian von
authors.initials: Cv
authors.lastname: Plessen
authors.forename: Marit
authors.initials: M
authors.lastname: Jordhøy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D015897:Comorbidity; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000401:mortality; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013921:Thrombocytopenia / Q000401:mortality; D055815:Young Adult; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine