title: Adjuvant chemotherapy and age-related biases in non-small cell lung cancer.
abstract: BACKGROUND
  Five-year survival for early-stage lung cancer despite complete surgical resection is approximately 50%. Adjuvant chemotherapy has been shown to improve survival in some patients. Older cancer patients do not always receive standard therapy. The purpose of this study was to determine if there were age-related biases concerning the use of adjuvant chemotherapy after lobectomy for elderly patients with non-small cell lung cancer (NSCLC).
  
  
  METHODS
  A prospective lung cancer outcomes database was queried for all patients undergoing lobectomy for NSCLC pathologic stage IB and higher between April 2006 and October 2010. Patients who received neoadjuvant treatment or who died within 30 days of operation were excluded. Ninety-nine patients met the inclusion criteria. Patients were divided into 2 groups based on age (<70 or ≥70 years). The use of adjuvant chemotherapy was compared between groups.
  
  
  RESULTS
  Sixty-nine patients (70%) were younger than 70 years and 30 (30%) were 70 years or older. There was a significant difference in the use of adjuvant chemotherapy between the 2 groups, with 46 (66.7%) of the younger patients and 7 (25%) of the elderly patients receiving adjuvant treatment (p<0.01). The difference persisted when analyzed by stage, with older patients less likely to receive chemotherapy among all patients with stage IB disease, stage II or more advanced disease, and stage IB lesions greater than or equal to 4 cm plus stage II or more advanced disease. In multivariate analysis of preoperative and postoperative factors, age remained the only independent predictor of chemotherapy use.
  
  
  CONCLUSIONS
  Patients undergoing lobectomy who were 70 years of age or older received adjuvant chemotherapy less often than did younger patients.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cininnati Veterans Affairs Medical Center, Cincinnati, Ohio 45267, USA.
authors.forename: Kelcie A
authors.initials: KA
authors.lastname: Rodriguez
authors.forename: Julian
authors.initials: J
authors.lastname: Guitron
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Valerie
authors.initials: V
authors.lastname: Williams
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Starnes
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015982:Bias; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents