Abstract
The mortality due to cancers of older patients, in age above 65 years of life, in comparison to younger is higher in majority of these diseases. It has been also reported that seniors are frequently denied the treatment according to current standards of therapy, thus suffer from undertreatment. There is solid evidence from controlled trials that older patients may tolerate pharmacological therapies in some cancers as well as young, providing they are under good supportive care. At the same time aggressive multimodal treatment may cause immediate or delayed side effects and exhaustion of reserves of the vital organs in elderly. This may cause a general deterioration, a decompensation of comorbidities, an evolution of geriatric syndromes and premature death, not directly caused by cancer. Such situation in aged cancer patients should be called the overtreatment. In diseases with better prognosis, with effective screening methods and large choice of treatment options like breast cancer, survival is getting better, although not in the eldest. The worse prognosis in old breast cancer patients may be caused to some extent by undertreatment. More fatal tumors like NSCLC await further optimization of cancer therapy towards better toxicity profile to avoid overtreatment.
References
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21. Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging. 2015, Vol. 6, 10, pp. 157-74.
22. Hughes KS, Schnaper LA, Cirrincione C, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer . J Clin Oncol. 28 (Suppl 15) Abstract 507, 2010.
23. Muss HB, Berry DA, Cirrincione CT, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. . N Engl J Med. 360, 2009, pp. 2055-65.
24. AJ., Wu. Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer. Transl Lung Cancer Res. Sep;8 , 2019, Vols. (Suppl 2):S135-S138. doi: 10.21037/tlcr.2019.08.08.
25. Dubaere E, Goffaux M, Wanet M, Bihin B, et al. Long term outcome after 48 Gy stereotactic ablative body radiotherapy for peripheral stage I non-small cell lung cancer. BMC Cancer. Jun 28;19(1):639. doi: 10.1186/s12885-019-5863-2., 2019.
26. Hoffman RM, Sanchez R. Lung Cancer Screening. Med Clin North Am. Jul;101(4):769-785. doi: 10.1016/j.mcna.2017.03.008., 2017.
27. Zhong WZ, Wang Q, Mao WM et al. Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II-IIIA (N1-N2) EGFR-mutant NSCLC (ADJUVANT/CTONG1104): a randomised, open-label, phase 3 study. . Lancet Oncol. Jan;19(1):139-148. doi: 10.1016/S1470-2045(17)30729-5. , 2018.
28. Rosell R, Karachaliou N. Adjuvant therapy for resected EGFR-mutant non-small-cell lung cancer. . Lancet Oncol. . 2018 Mar;19(3):e126. doi: 10.1016/S1470-2045(18)30071-8.
29. Miller, E.D., Fisher, J.L., Haglund, K.E. et al. Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database. . Radiat Oncol 13, 196 (2018) doi:10.1186/s1301.
30. Atagi S, Kawahara M, Yokoyama A,et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol. 2012 Jul;13(7):671-8. doi: 10.1016/S1470-2045(12)70139-0.
31. Miller ED, Fisher JL, Haglund KE et al. The Addition of Chemotherapy to Radiation Therapy Improves Survival in Elderly Patients with Stage III Non-Small Cell Lung Cancer. J Thorac Oncol. 2018 Mar;13(3):426-435. doi: 10.1016/j.jtho.2017.11.135.
32. Kim DY, Song C, Kim SH et al. Chemoradiotherapy versus radiotherapy alone following induction chemotherapy for elderly patients with stage III lung cancer. Radiat Oncol J. 2019 Sep;37(3):176-184. doi: 10.3857/roj.2019.00087.
33. Abe T, Takeda K, Ohe Y, Kudoh S et al. Randomized phase III trial comparing weekly docetaxel plus cisplatin versus docetaxel monotherapy every 3 weeks in elderly patients with advanced non-small-cell lung cancer: the intergroup trial JCOG0803/WJOG4307L. . J Clin Oncol. 2015 Feb 20;33(6):575-81. doi: 10.1200/JCO.2014.55.8627.
34. Sandler A, Gray R, Perry MC, Brahmer J et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. . N Engl J Med. 2006 Dec 14;355(24):2542-50.
35. Carmichael JA, Wing-San Mak D, O'Brien M. A. Review of Recent Advances in the Treatment of Elderly and Poor Performance NSCLC. . Cancers (Basel). 2018 Jul 18;10(7). pii: E236. doi: 10.3390/cancers10070236. .
36. Khan M, Lin J, Liao G, Tian Y et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018 Aug;97(33):e11936. doi:. Medicine (Baltimore). 2018 Aug;97(33):e11936. doi: 10.1097/MD.0000000000011936.
37. Wu Y, Ju Q, Qian B et al. The effectiveness of PD-1 inhibitors in non-small cell lung cancer (NSCLC) patients of different ages. . Oncotarget. 2017 Dec 26;9(8):7942-7948. doi: 10.18632/oncotarget.23678.
2. Wojciechowska U, Didkowska J. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie. Dostępne na stronie http://onkologia.org.pl/raporty/ access: Nov 03, 2019. [Online]
3. Kocik J, Pajączek M, Kryczka T. Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland. BMC Cancer. Jul 30, 2019.
4. Baban CK, Devane L, Geraghty J. Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients? Ir J Med Sci. 2018 Jun 23. . 2018 Jun 23. .
5. Varghese F, Wong J. Breast Cancer in the Elderly. Surg Clin North Am. 2018, Vol. 98, 4 819-833, pp. 819-833.
6. Wallwiener CW, Hartkopf AD, Grabe E, Wallwiener M, Taran FA, Fehm T, Brucker SY, Krämer B. Adjuvant chemotherapy in elderly patients with primary breast cancer: are women ≥65 undertreated? J Cancer Res Clin Oncol. . 2016, Vol. 142, 8, pp. 1847-53.
7. Schonberg MA, Marcantonio ER, Li D, et al. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol. 28 2010, pp. 2038–2045.
8. Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schäfer P, Kurtz J, Sappino AP, Vlastos G. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003, Vol. 21(19), pp. 3580-7.
9. Malik MK, Tartter PI, Belfer R. Undertreated Breast Cancer in the Elderly. Journal of Cancer Epidemiology. 2013, 893194.
10. Derks MGM, Bastiaannet E, Kiderlen M, Hilling DE, Boelens PG, Walsh PM, van Eycken E, Siesling S, Broggio J, Wyld L, Trojanowski M, Kolacinska A, Chalubinska-Fendler J, Gonçalves AF, Nowikiewicz T, Zegarski W, Audisio RA, Liefers GJ, Portielje JEA,. Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group. Br J Cancer. 2018.
11. Hind D, Wyld L, Reed MW. Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Cancer. 2007, Vol. 96, 7, pp. 1025-1029.
12. Pettke E, Ilonzo N, Ayewah M, et al. Short-term, postoperative breast cancer outcomes in patients with advanced age. Am J Surg. 2016, Vol. 12(4), pp. 677–81.
13. Montroni I, Rocchi M, Santini D, et al. Has breast cancer in the elderly remained the same over recent decades? A comparison of two groups of patients 70 years. J Geriatr Oncol. 2014, Vol. 5(3), pp. 260-5.
14. Chagpar AB, Hatzis C, Pusztai L, et al. Association of LN evaluation with survival in women aged 70 years or older with clinically node-negative hormone receptor positive breast cancer. Ann Surg Oncol. 2017, Vol. 24(10), pp. 3073-81.
15. Welsh JL, Hoskin TL, Day CN, et al. Predicting nodal positivity in women 70 years of age and older with hormone receptor-positive breast cancer to aid incorporation of a society of surgical oncology choosing wisely guideline into clinical practice. Ann Surg Oncol. 2017, Vol. 24(10), pp. 2881-8.
16. Martelli G, Miceli R, Daidone MG, et al. Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol. 18(1), 2011, pp. 125-33.
17. Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013, Vol. 14, pp. 297-305.
18. Pepels MJ, de Boer M, Bult P, van Dijck JA, van Deurzen CH, Menke-Pluymers MB, et al. Regional recurrence in breast cancer patients with sentinel node micrometastases and isolated tumor cells. Ann Surg. 2012, Vol. 255(1), pp. 116-21.
19. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel. Radiotherapy or surgery of the axilla after a positive senintel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014, Vol. 15, pp. 1303-10.
20. de Boniface J, Frisell J, Andersson Y, Bergkvist L, Ahlgren J, Rydén L, Olofsson Bagge R, Sund M, Johansson H, Lundstedt D and Group, SENOMAC Trialists’. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017, Vol. 17(1), p. 379.
21. Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging. 2015, Vol. 6, 10, pp. 157-74.
22. Hughes KS, Schnaper LA, Cirrincione C, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer . J Clin Oncol. 28 (Suppl 15) Abstract 507, 2010.
23. Muss HB, Berry DA, Cirrincione CT, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. . N Engl J Med. 360, 2009, pp. 2055-65.
24. AJ., Wu. Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer. Transl Lung Cancer Res. Sep;8 , 2019, Vols. (Suppl 2):S135-S138. doi: 10.21037/tlcr.2019.08.08.
25. Dubaere E, Goffaux M, Wanet M, Bihin B, et al. Long term outcome after 48 Gy stereotactic ablative body radiotherapy for peripheral stage I non-small cell lung cancer. BMC Cancer. Jun 28;19(1):639. doi: 10.1186/s12885-019-5863-2., 2019.
26. Hoffman RM, Sanchez R. Lung Cancer Screening. Med Clin North Am. Jul;101(4):769-785. doi: 10.1016/j.mcna.2017.03.008., 2017.
27. Zhong WZ, Wang Q, Mao WM et al. Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II-IIIA (N1-N2) EGFR-mutant NSCLC (ADJUVANT/CTONG1104): a randomised, open-label, phase 3 study. . Lancet Oncol. Jan;19(1):139-148. doi: 10.1016/S1470-2045(17)30729-5. , 2018.
28. Rosell R, Karachaliou N. Adjuvant therapy for resected EGFR-mutant non-small-cell lung cancer. . Lancet Oncol. . 2018 Mar;19(3):e126. doi: 10.1016/S1470-2045(18)30071-8.
29. Miller, E.D., Fisher, J.L., Haglund, K.E. et al. Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database. . Radiat Oncol 13, 196 (2018) doi:10.1186/s1301.
30. Atagi S, Kawahara M, Yokoyama A,et al. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol. 2012 Jul;13(7):671-8. doi: 10.1016/S1470-2045(12)70139-0.
31. Miller ED, Fisher JL, Haglund KE et al. The Addition of Chemotherapy to Radiation Therapy Improves Survival in Elderly Patients with Stage III Non-Small Cell Lung Cancer. J Thorac Oncol. 2018 Mar;13(3):426-435. doi: 10.1016/j.jtho.2017.11.135.
32. Kim DY, Song C, Kim SH et al. Chemoradiotherapy versus radiotherapy alone following induction chemotherapy for elderly patients with stage III lung cancer. Radiat Oncol J. 2019 Sep;37(3):176-184. doi: 10.3857/roj.2019.00087.
33. Abe T, Takeda K, Ohe Y, Kudoh S et al. Randomized phase III trial comparing weekly docetaxel plus cisplatin versus docetaxel monotherapy every 3 weeks in elderly patients with advanced non-small-cell lung cancer: the intergroup trial JCOG0803/WJOG4307L. . J Clin Oncol. 2015 Feb 20;33(6):575-81. doi: 10.1200/JCO.2014.55.8627.
34. Sandler A, Gray R, Perry MC, Brahmer J et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. . N Engl J Med. 2006 Dec 14;355(24):2542-50.
35. Carmichael JA, Wing-San Mak D, O'Brien M. A. Review of Recent Advances in the Treatment of Elderly and Poor Performance NSCLC. . Cancers (Basel). 2018 Jul 18;10(7). pii: E236. doi: 10.3390/cancers10070236. .
36. Khan M, Lin J, Liao G, Tian Y et al. Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018 Aug;97(33):e11936. doi:. Medicine (Baltimore). 2018 Aug;97(33):e11936. doi: 10.1097/MD.0000000000011936.
37. Wu Y, Ju Q, Qian B et al. The effectiveness of PD-1 inhibitors in non-small cell lung cancer (NSCLC) patients of different ages. . Oncotarget. 2017 Dec 26;9(8):7942-7948. doi: 10.18632/oncotarget.23678.
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