Effectiveness of cancer care in the elderly

Many studies show that the elderly often do not receive potentially life-saving chemotherapy

or radiation therapy. This is for a number of reasons, including concerns regarding their ability

to tolerate the side effects of chemotherapy, reluctance on the part of older patients to accept

chemotherapy, and other factors. Not much research has explored whether chemotherapy

works as well in the elderly as in other age groups. We are utilizing a new database, a linkage

between Medicare and seer, to investigate the use of chemotherapy in people over the age 65.

In our prior grant (2001-2003), we looked at three settings: 1) the use of adjuvant

chemotherapy for stage III colon cancer; 2) the use of radiation therapy and chemotherapy for

stages II and III rectal cancer; and 3) the use of platinum-based chemotherapy for stages III and

IV ovarian cancers. These are all settings for which randomized trials have demonstrated the

efficacy of these treatments and it has become standard of care. Our studies have shown that

age was indeed a factor in decreased use of these treatments in patients, as was the number of

comorbidities (other diseases which the patient had). However, for those treated who were

greater than 65 years of age, the chemotherapy had essentially the same beneficial effect on

survival as had been demonstrated in prior studies for other age groups.

In this resubmission of a renewal application we propose to investigate a different three

settings: 1) the use of chemotherapy and radiation therapy for localized small cell lung

cancer;2) the use of chemotherapy either prior to or following cystectomy (removal of the

bladder) for bladder cancer; and 3) the use of chemotherapy for aggressive large cell

non-Hodgkin's lymphoma in the elderly. Again, we seek to explore whether the elderly

received these treatments, what determines whether they received them or not, how effective

these treatments are in this age group, and how delays or non-receipt of optimal chemotherapy

affects survival.

Overall, we hope to establish that the withholding of these potentially active chemotherapy

regimens from older patients leads to increased mortality in a setting in which a more

aggressive approach would reduce cancer-related mortality.