Age, Other Health Factors Can Play a Role in Cancer Treatment Decisions

Age, comorbidities and the other drugs a patient is taking can affect whether or not someone with advanced cancer receives systemic treatment – meaning drugs like chemotherapy or hormone therapy that affect the whole body – according to recent research.

Researchers analyzed 17,228 adult patients with all stages of multiple myeloma, stages 3-4 non-Hodgkin’s lymphoma, breast cancer, colorectal cancer and prostate cancer, and stage 4 lung cancer and ovarian cancer.

About a fourth (24%) of patients were younger than 60 years of age; 26% were between 60 and 69; 26% were between 70 and 79; 19% were between 80 and 89; and 5% were 90 years or older. Half (50%) of the total patient population received systemic therapy.

“We saw significant drop-offs really starting in either the 60s or 70s – especially in the 70s and 80s,” said study author Dr. David Dawe, assistant professor at the Max Rady College of Medicine at the University of Manitoba in Winnipeg, Canada. “For hematologic tumors, like non-Hodgkin lymphoma or multiple myeloma… we again saw less drop-off until people were in their 80s. I think that’s because those are highly responsive cancers to the treatment.”

The researchers found that patients who had increased use of health care resources, more comorbidities, unknown cancer stage, higher age and the use of multiple other drugs had a statistically decreased chance that they receive systemic therapy.

Variation of systemic therapy use relied somewhat on the on the types of treatments that are commonly used in each cancer type.

“The drop-offs (of systemic therapy use) are most notable in the cancers where non-cytotoxic systemic therapy options don’t really exist or didn’t exist a whole lot between 2004 and 2015, which was the timeframe of diagnoses for our study,” Dawe said. “Conversely, cancers with a large amount of hormone-associated therapies, such as prostate cancer or breast cancer, maintain the rates of treatment for people in their 70s and even to a greater extent into their 80s.”

While patients with stage 3 and 4 cancer tended to have similar rates of systemic therapy use at older ages, those with stage 3 tended to receive systemic therapy more often than those diagnosed with stage 4 cancer at younger ages. Age, however, did not interact with comorbidity or polypharmacy (utilizing six or more other drugs).

“The relationship between those factors did not change over the course of age,” Dawe explained.

This study shows treatment trends but should not be seen as a one-size-fits-all approach. Regardless of age or other health complications, patients should talk about their best treatment options with their cancer care team.

“When it comes to systemic therapy, a fit 80-year-old may well be able to tolerate the same treatment as a less-fit 65-year-old,” Dawe said. “So if you’re feeling well, you’re functioning well and you don’t have a whole lot of other health conditions, then think about the cancer you’re being diagnosed with.”

However, patients should consider the risks and benefits with treatments.

“On the other hand, if you have a lot of other health conditions, you're having a really hard time day to day, then you may need to not eliminate hope. But you may need to temper that hope with acknowledging that the treatments that we have can be helpful for some, but can also be harmful for others. And so we need to be careful about who we're putting through,” Dawe said.

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