Skip to main content

Advertisement

SpringerLink
Log in

Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians

  • Research Articles
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

Lung cancer chemotherapy decisions in patients ≥70 years old are complex because of toxicity, comorbidity and the limited data on patient preferences. We examined the relationships between preferences and chemotherapy use in this group of patients.

Methods and patients

We used a questionnaire describing four hypothetical lung cancer treatment options. Eighty-three elderly (≥70 years old) lung cancer patients were informed about their diagnosis and therapeutic choices and then asked to choose one of the four options. Patients had previously been included in a prospective study to explore geriatric evaluation in an oncology unit and all had given written informed consent.

Results

Older patients (n=83) diagnosed with lung cancer (non-small- and small-cell lung cancer) from January 2006 to February 2008 were recruited from a single centre. The mean patient age was 77 years (range: 70–91). Eighty-one patients (97.6%) were men. Non-small-cell lung cancer (NSCLC) was the diagnosis in 63 patients (76%). Most patients selected active treatment (38.6% most survival benefit, 18% less survival benefit) and 31.3% selected no active treatment. Elderly lung cancer patients were significantly more likely to accept aggressive treatments despite high reported toxicities. Although most of the patients were symptomatic at diagnosis, the “symptom relief” option was chosen less frequently than the options that could prolong survival. Factors significantly related to patients’ attitude toward chemotherapy were age (p<0.001), frailty (p=0.0039), depression and poor performance status (PS).

Conclusion

Elderly lung cancer patients want to be involved in the decision-making process. Survival was the main treatment objective for more than half of the patients in this study. We have not found other published studies about elderly lung cancer patients’ decisions about chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Azzoli CG, Baker S Jr, Temin S et al (2010) American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 28:620–627

    Article  Google Scholar 

  2. Lang K, Marciniak MD, Faries D et al (2009) Trends and predictors of first-line chemotherapy use among elderly patients with advanced nonsmall cell lung cancer in the United States. Lung Cancer 63:264–270

    Article  PubMed  Google Scholar 

  3. Jacob S, Hovey E, Ng W et al (2010) Estimation of an optimal chemotherapy utilisation rate for lung cancer: an evidence-based benchmark for cancer care. Lung Cancer 69:307–314

    Article  PubMed  Google Scholar 

  4. Davidoff AJ, Tang M, Seal B et al (2010) Chemotherapy and survival benefit in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 28:2191–2197

    Article  PubMed  Google Scholar 

  5. Blinman P, Alam M, Duric V et al (2010) Patients’ preferences for chemotherapy in non-small-cell lung cancer: a systematic review. Lung Cancer 69:141–147

    Article  PubMed  Google Scholar 

  6. Mandelblatt JS, Sheppard VB, Hurria A et al (2010) Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians. J Clin Oncol 28:3146–3153

    Article  PubMed  Google Scholar 

  7. Foster JA, Salinas GD, Mansell D et al (2010) How does older age influence oncologists’ cancer management? Oncologist 15:584–592

    Article  PubMed  Google Scholar 

  8. Kefeli U, Kaya S, Ustaalioglu BO et al (2010) Prognostic factors in elderly patients with nonsmall cell lung cancer: a two-center experience. Med Oncol 28:661–666

    Article  PubMed  Google Scholar 

  9. Koedoot CG, de Haan RJ, Stiggelbout AM et al (2003) A prospective study explaining patients’ treatment preference and choice. Palliative chemotherapy or best supportive care? Br J Cancer 89:219–293

    Article  Google Scholar 

  10. Droz JP, Aapro M, Balducci L (2008) Overcoming challenges associated with chemotherapy treatment in the senior adult population. Crit Rev Oncol Hematol 68S:S1–S8

    Article  Google Scholar 

  11. Koedoot CG, De Haes JC, Heisterkamp SH et al (2002) Palliative chemotherapy or watchful waiting? A vignettes study among oncologists. J Clin Oncol 20:3685–3664

    Article  Google Scholar 

  12. Langer CJ, Manola J, Bernardo P et al (2002) Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Natl Cancer Inst 94:173–181

    Article  PubMed  Google Scholar 

  13. Pallis AG, Gridelli C, van Meerbeeck JP et al (2010) EORT Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts’ opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 21:692–706

    Article  PubMed  CAS  Google Scholar 

  14. Costa GJ, Fernandes AL, Pereira JR et al (2006) Survival rates and tolerability of platinum-based chemotherapy regimens for elderly patients with non-small-cell lung cancer (NSCLC). Lung Cancer 53:171–176

    Article  PubMed  Google Scholar 

  15. Chrischilles EA, Pendergast JF, Kahn KL et al (2009) Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer. J Clin Oncol 27:6251–6266

    Article  Google Scholar 

  16. Nordin AJ, Chinn DJ, Moloney I et al (2001) Do elderly patients care about cure? Attitudes to radical gynecologic oncology surgery in the elderly. Gynecol Oncol 81:447–455

    Article  PubMed  CAS  Google Scholar 

  17. Hirose T, Horichi N, Ohmori T et al (2005) Patient preferences in chemotherapy for advanced nonsmall-cell lung cancer. Intern Med 44:107–113

    Article  PubMed  Google Scholar 

  18. Brundage MD, Davidson JR, Mackillop WJ (1997) Trading treatment toxicity for survival in locally advanced non-small cell lung cancer. J Clin Oncol 15:330–340

    PubMed  CAS  Google Scholar 

  19. Chouliara Z, Miller M, Stott D et al (2004) Older people with cancer: perceptions and feelings about information, decision-making and treatment — a pilot study. Eur J Oncol Nurs 8:257–261

    Article  PubMed  Google Scholar 

  20. Slevin ML, Stubbs L, Plant HJ et al (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses and general public. BMJ 300:1458–1460

    Article  PubMed  CAS  Google Scholar 

  21. Chu D-T, Kim S-W, Kuo H-P et al (2007) Patient attitudes towards chemotherapy as assessed by patient versus physician: a prospective observational study in advanced non-small cell lung cancer. Lung Cancer 56:433–443

    Article  PubMed  Google Scholar 

  22. Perez EA (1998) Perceptions of prognosis, treatment and treatment impact on prognosis in nonsmall cell lung cancer. Chest 114:593–604

    Article  PubMed  CAS  Google Scholar 

  23. Gridelli C (2002) Does chemotherapy have a role as palliative therapy for unfit or elderly patients with non-small-cell lung cancer? Lung Cancer 38[Suppl 2]:S45–50

    Article  Google Scholar 

  24. Extermann M, Albrand G, Chen H et al (2003) Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol 21:3214–3219

    Article  PubMed  Google Scholar 

  25. Elkin EB, Kim SHM, Casper ES et al (2007) Desire for information and involvement in treatment decisions: elderly cancer patients’ preferences and their physicians’ perceptions. J Clin Oncol 25:5275–5280

    Article  PubMed  Google Scholar 

  26. Silvestri G, Pritchard R, Welch HG (1998) Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 317:771–775

    Article  PubMed  CAS  Google Scholar 

  27. Brundage MD, Feldman-Stewart D, Cosny R et al (2001) Cancer patients’ attitudes toward treatment options for advanced non-small cell lung cancer: implications for patient education and decision support. Pat Educ Consl 45:149–157

    Article  CAS  Google Scholar 

  28. Hirose T, Yamaoka T, Ohnishi T et al (2009) Patient willingness to undergo chemotherapy and thoracic radiotherapy for locally advanced non-small cell lung cancer. Psychooncology 18:483–489

    Article  PubMed  Google Scholar 

  29. Voogt E, van der Heide A, Rietjens JA et al (2005) Attitudes of patients with incurable cancer toward medical treatment in the last phase of life. J Clin Oncol 23:2012–2019

    Article  PubMed  Google Scholar 

  30. Weeks JC, Cook EF, O’Day SJ et al (1998) Relationship between cancer patients predictions of prognosis and their treatment preferences. JAMA 279:1709–1714

    Article  PubMed  CAS  Google Scholar 

  31. Pronzato P, Bertelli G, Losardo P et al (1994) What do advanced cancer patients know of their disease? A report from Italy. Support Care Cancer 2:242–244

    Article  PubMed  CAS  Google Scholar 

  32. Quirt CF, Mackillop WJ, Ginsburg AD et al (1997) Do doctors know when their patient don’t? A survey of doctor-patient communication in lung cancer. Lung Cancer 18:1–20

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Oncology Unit, Hospital Lluís Alcanyís, Crta. Xàtiva a Silla, km. 2, ES-46800, Xàtiva, Valencia, Spain

    Regina Gironés & Dolores Torregrosa

  2. Medical Oncology Service, University Hospital La Fe, Valencia, Spain

    José Gómez-Codina

  3. Medical Oncology Unit, Hospital Doctor Peset, Valencia, Spain

    Inma Maestu

  4. Investigation Unit, La Mancha Centro Hospital, Alcázar de San Juan, Ciudad Real, Spain

    Jose María Tenias

  5. Medical Oncology Service Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

    Rafael Rosell

Authors
  1. Regina Gironés
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dolores Torregrosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. José Gómez-Codina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inma Maestu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jose María Tenias
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rafael Rosell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Regina Gironés.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gironés, R., Torregrosa, D., Gómez-Codina, J. et al. Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians. Clin Transl Oncol 14, 183–189 (2012). https://doi.org/10.1007/s12094-012-0782-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0782-6

Keywords

Search

Navigation