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Undertreatment Is Common Among Elderly Patients With Early-Stage Breast Cancer and Non-Hodgkin’s Lymphoma

Undertreatment Is Common Among Elderly Patients With Early-Stage Breast Cancer and Non-Hodgkin’s Lymphoma

TAMPA, Florida—Giving suboptimal care, in terms of chemotherapy
regimens and dose intensities, is "compromising survival" of
elderly patients, according to a report by Julie Meyer, MPH, of a study
involving close to 24,000 patients with early stage breast cancer and
non-Hodgkin’s lymphoma. Ms. Meyer is a nurse practitioner in the Senior
Adult Oncology Program at H. Lee Moffitt Cancer Center and Research
Institute in Tampa, Florida.

The study examined records from 1,243 community oncology practices for
20,799 patients with early-stage breast cancer and for 3,165 with
non-Hodgkin’s lymphoma. The researchers defined suboptimal treatment (or
low planned dose on time) as less than 85% of the planned dose intensity for
breast cancer and less than 80% for the non-Hodgkin’s lymphoma regimen.

Among the breast cancer patients, the percentages for those receiving
suboptimal care was 27.8% of those over 65 vs 20.8% of younger patients
receiving CMF (cyclophosphamide/methotrexate/fluorouracil) therapy, 28.1% of
those over 65 vs 23.7% of younger patients receiving CAF
(cyclophosphamide/doxorubicin/fluorouracil), and 14.7% of those over 65 vs
10.2% of younger patients receiving AC (doxorubicin/cyclophosphamide). Among
the non-Hodgkin’s lymphoma patients receiving CHOP (cyclophosphamide
[Cytoxan]/doxorubicin/vincristine [Oncovin]/prednisone), 42% of those over
65 were undertreated, compared to 23% of younger patients.

"Physicians say they’re giving [elderly patients] standard care, but they’re not," Ms. Meyer said.
Because persons of differing ages who receive similar chemotherapy regimens
experience similar survival rates, giving suboptimal treatment to elderly
patients is thereby "compromising survival," she added.

Hematopoietic Growth Factors

Elderly cancer patients run a higher risk of treatment-induced
myelosuppression, especially neutropenia, and suffer more infections and
more severe infections than younger people. These conditions often cause
reductions and delays in planned chemotherapy, Ms. Meyer said, but need not
translate into dose-limiting toxicities when hematopoietic growth factors
are used. Nonetheless, only 10% of elderly cancer patients receive growth
factors proactively, she noted. Instead, among the great majority of
physicians, the "attitude is ‘let’s just see if they need it,’"
she said.

In addition, she said, when growth factors are prescribed, Medicare
requires that patients come to a physician’s office for these daily shots,
though insurance providers generally permit younger patients to give
themselves the shots at home. The perceived inconvenience of these office
visits, she suggested, encourages many physicians to forego prescribing
proactive growth factors.


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