title: Population-based outcomes research on treatment patterns and impact of chemotherapy in older patients with metastatic gastric cancer.
abstract: OBJECTIVE
  Older patients with cancer are underrepresented in clinical trials, and thus, limited data are available on older patients with metastatic gastric cancer (MGC). This study was conducted to assess patterns of care, and outcomes of chemotherapy and its predictors, in older patients with MGC.
  
  
  METHODS
  Using the Korean Health Insurance Review and Assessment Service (HIRA) database, a nationwide population-based outcomes study was conducted. From the HIRA database, patients newly diagnosed with MGC in 2010 were identified (N = 1871).
  
  
  RESULTS
  Patients aged ≥70 years were defined as older patients (N = 792) and those aged <70 years as younger patients (N = 1079). Compared with younger patients, fewer older patients were diagnosed with MGC and received cancer treatment at high-volume medical institutions. Palliative chemotherapy was less frequently administered in older patients than in younger patients. In multivariate analyses, although combination chemotherapy as the first-line treatment (vs. monotherapy) and salvage chemotherapy after first-line chemotherapy (vs. no salvage chemotherapy) conferred more prolonged survival in the entire patient population, first-line combination chemotherapy did not provide an additional survival benefit in older patients compared to monotherapy.
  
  
  CONCLUSIONS
  We found several barriers for older patients in approaching high-quality medical resources or receiving appropriate treatments. Although age was not an independent prognostic factor for survival in MGC, palliative chemotherapy was less frequently used in older patients. In our analysis, combination chemotherapy as the first-line treatment did not provide an additional benefit to older patients compared to monotherapy.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Keun-Wook
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Ji-Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea. jhkimmd@snu.ac.kr.
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult
keywords: Chemotherapy; Gastric cancer; Older patients; Outcomes research