Undertreatment as a Cause of Poor Outcomes in Elderly Patients: Evidence From Surveys of Practice Patterns in Early-Stage Breast Cancer and Non-Hodgkin's Lymphoma

2.50
Hdl Handle:
http://hdl.handle.net/10755/165538
Category:
Abstract
Type:
Presentation
Title:
Undertreatment as a Cause of Poor Outcomes in Elderly Patients: Evidence From Surveys of Practice Patterns in Early-Stage Breast Cancer and Non-Hodgkin's Lymphoma
Author(s):
Meyer, Julie
Author Details:
Julie Meyer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
Abstract:
It is widely held that elderly patients benefit less from chemotherapy than younger patients. Older patients are more susceptible to the dose-limiting toxicities of chemotherapy, particularly myelotoxicity, but several studies have shown that with equal treatment and appropriate supportive care otherwise-healthy elderly patients can obtain outcomes equal to those of younger patients. This suggests that under treatment may be a primary cause of poor responses in elderly patients. To investigate under treatment of elderly patients in actual practice, we analyzed data from two large surveys of nationwide practice patterns in the treatment of early-stage breast cancer (ESBC) and non-Hodgkin's lymphoma (NHL). The ESBC database contained records on 20,799 patients treated at 1,243 community oncology practices with multiple cycles of adjuvant chemotherapy (96% treated with CMF, CAF, or AC); the NHL database contained records on 3,165 patients treated at 405 practices with primary chemotherapy (all CHOP, CNOP, or CVP) for intermediate-grade lymphoma. The primary end point was low planned dose on time (PDOT), defined as less than 85% of planned dose intensity for ESBC and less than 80% for NHL. In the ESBC database, 16.5% of patients were aged 65 years or older. CMF was administered to 43.6% of all patients and 57.4% of patients 65 years of age or older. Patients 65 or older were more likely than younger patients to have been given low PDOT with CMF (27.8% versus 20.6%, P < .001), CAF (29.1% versus 23.7%, P < .01), and AC (14.7% versus 10.2%, P < .001). In the NHL database, 49% of patients were aged 65 years or older. Patients 65 or older were less likely than younger patients to have been given CHOP (76% versus 89%, P < .001), and more likely to have planned (27% versus 12%, P < .001) and received (42% versus 23%, P < .001) low PDOT relative to standard CHOP. These results indicate that elderly patients with ESBC and NHL frequently receive less-than-optimal treatment in terms of both regimen and dose intensity. Nurses can improve outcomes in elderly patients by ensuring that less-aggressive treatment is truly indicated; when not, standard treatment with appropriate supportive measures such as prophylactic growth factors to ameliorate the greater dose-limiting toxicities associated with aging should be considered.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
27th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleUndertreatment as a Cause of Poor Outcomes in Elderly Patients: Evidence From Surveys of Practice Patterns in Early-Stage Breast Cancer and Non-Hodgkin's Lymphomaen_GB
dc.contributor.authorMeyer, Julieen_US
dc.author.detailsJulie Meyer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USAen_US
dc.identifier.urihttp://hdl.handle.net/10755/165538-
dc.description.abstractIt is widely held that elderly patients benefit less from chemotherapy than younger patients. Older patients are more susceptible to the dose-limiting toxicities of chemotherapy, particularly myelotoxicity, but several studies have shown that with equal treatment and appropriate supportive care otherwise-healthy elderly patients can obtain outcomes equal to those of younger patients. This suggests that under treatment may be a primary cause of poor responses in elderly patients. To investigate under treatment of elderly patients in actual practice, we analyzed data from two large surveys of nationwide practice patterns in the treatment of early-stage breast cancer (ESBC) and non-Hodgkin's lymphoma (NHL). The ESBC database contained records on 20,799 patients treated at 1,243 community oncology practices with multiple cycles of adjuvant chemotherapy (96% treated with CMF, CAF, or AC); the NHL database contained records on 3,165 patients treated at 405 practices with primary chemotherapy (all CHOP, CNOP, or CVP) for intermediate-grade lymphoma. The primary end point was low planned dose on time (PDOT), defined as less than 85% of planned dose intensity for ESBC and less than 80% for NHL. In the ESBC database, 16.5% of patients were aged 65 years or older. CMF was administered to 43.6% of all patients and 57.4% of patients 65 years of age or older. Patients 65 or older were more likely than younger patients to have been given low PDOT with CMF (27.8% versus 20.6%, P &lt; .001), CAF (29.1% versus 23.7%, P &lt; .01), and AC (14.7% versus 10.2%, P &lt; .001). In the NHL database, 49% of patients were aged 65 years or older. Patients 65 or older were less likely than younger patients to have been given CHOP (76% versus 89%, P &lt; .001), and more likely to have planned (27% versus 12%, P &lt; .001) and received (42% versus 23%, P &lt; .001) low PDOT relative to standard CHOP. These results indicate that elderly patients with ESBC and NHL frequently receive less-than-optimal treatment in terms of both regimen and dose intensity. Nurses can improve outcomes in elderly patients by ensuring that less-aggressive treatment is truly indicated; when not, standard treatment with appropriate supportive measures such as prophylactic growth factors to ameliorate the greater dose-limiting toxicities associated with aging should be considered.en_GB
dc.date.available2011-10-27T12:20:28Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:20:28Z-
dc.conference.date2002en_US
dc.conference.name27th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationWashington, D.C., USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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