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Killingberg KT, Grønberg BH, Slaaen M, Kirkevold Ø, Halvorsen TO. Treatment Outcomes of Older Participants in a Randomized Trial Comparing Two Schedules of Twice-Daily Thoracic Radiotherapy in Limited-Stage SCLC. J Thorac Oncol 2023; 18:803-812. [PMID: 36716960 DOI: 10.1016/j.jtho.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/04/2022] [Accepted: 01/15/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Half of the patients with limited-stage SCLC (LS SCLC) are above or equal to 70 years old, but they account for less than 20% of participants in most trials. Comorbidities and reduced organ and physical function might lead to more treatment toxicity, and population-based studies indicate that fewer older than younger patients with LS SCLC receive standard chemoradiotherapy, although there is limited evidence for such a policy. METHODS We compared baseline characteristics, comorbidity, survival, treatment completion, toxicity, health-related quality of life, and treatment outcomes between patients above or equal to 70 years old and those younger than 70 years old in an open-label, randomized phase II trial comparing twice-daily thoracic radiotherapy of 45 Gy in 30 fractions with 60 Gy in 40 fractions in LS SCLC. All patients received concurrent i.v. cisplatin (75mg/m2) or carboplatin (AUC 5-6 mg/ml x min) day 1 and i.v. etoposide (100 mg/m2) day 1-3 chemotherapy. This trial is registered at ClinicalTrials.gov (NCT02041845). RESULTS A total of 170 patients who were above or equal to 18 years old and had performance status of 0 to 2 were randomized. Of these, 53 patients (60 Gy: 25, 45 Gy: 28) were above or equal to 70 years old and 117 (60 Gy: 64, 45 Gy: 53) were younger. There were no differences in baseline characteristics, treatment completion rates, toxicity, or response rates across the age groups. Health-related quality of life mean scores were similar during year one, but older patients reported more decline on functional scales than younger patients during year two. Overall survival was shorter for older patients, whereas there was no difference in progression-free survival or time to progression. CONCLUSIONS Patients above or equal to 70 years old tolerated concurrent twice-daily chemoradiotherapy and achieved similar disease control as younger patients, indicating older patients should receive the same treatment as younger patients.
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Affiliation(s)
- Kristin Toftaker Killingberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Slaaen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; The Research Centre for Age-related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age-related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway; The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Health Science in Gjøvik, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tarje Onsøien Halvorsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Soares M, Antunes L, Redondo P, Borges M, Grimson F, Hermans R, Chaib C, Lacoin L, Juarez-Garcia A, Daumont MJ, Penrod JR, Bento MJ, Gonçalves FR. Small cell lung cancer treatment and survival in Portugal: A retrospective analysis from the I-O Optimise initiative. Eur J Cancer Care (Engl) 2021; 30:e13496. [PMID: 34288191 PMCID: PMC9285943 DOI: 10.1111/ecc.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/11/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
Objective We aim to describe treatment patterns and overall survival (OS) among a Portuguese cohort of patients with small cell lung cancer (SCLC). Methods This study utilised a database held by IPO‐Porto, Portugal's largest oncology hospital. Adult patients diagnosed with SCLC at IPO‐Porto between January 2012 and June 2017, with follow‐up to December 2017, were included. Patients were stratified into subgroups with limited disease (LD) or extensive disease (ED). Treatment analyses were performed from 2015 onwards. Results Overall, 227 patients diagnosed with SCLC (37 LD; 190 ED) were analysed. Median OS (interquartile range [IQR]) was 15.0 months (3.8–39.3) for LD‐SCLC and 5.0 months (1.7–10.3) for ED‐SCLC. Among 19 patients diagnosed with LD‐SCLC from 2015 onwards, 12 (63.2%) received initial treatment with systemic anticancer therapy (SACT) ± radiotherapy; 6 (31.6%) received best supportive care (BSC). Among 89 patients with ED‐SCLC, 57 (68.5%) received SACT ± palliative radiotherapy; 28 (31.5%) received BSC. For patients receiving platinum doublet chemotherapy (±radiotherapy), median OS (IQR) was not reached for LD‐SCLC and 5.4 months (2.3–10.9) for ED‐SCLC. Conclusion This real‐world data analysis from a large Portuguese oncology hospital demonstrates a high disease burden for patients diagnosed with SCLC, particularly those with ED, and highlights a need for more effective therapies.
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Affiliation(s)
- Marta Soares
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Luís Antunes
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Laboratory, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Marina Borges
- Outcomes Research Laboratory, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | | | | | - Carlos Chaib
- Research & Development Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | | | | | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Go SI, Park MJ, Lee GW. Clinical significance of the cachexia index in patients with small cell lung cancer. BMC Cancer 2021; 21:563. [PMID: 34001060 PMCID: PMC8130111 DOI: 10.1186/s12885-021-08300-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer cachexia worsens the treatment outcomes of patients with small-cell lung cancer (SCLC). However, no reliable biomarker of cancer cachexia is yet known. Methods We retrospectively evaluated male SCLC patients who received induction chemotherapy or concurrent chemoradiotherapy. The cachexia index (CXI) was calculated as skeletal muscle index × serum albumin level (g/dL)/neutrophil-to-lymphocyte ratio. The CXI cutoff according to tumor stage was determined based on a time-dependent receiver operating characteristic curve, and all patients were divided into low- and high-CXI groups. Results Of 267 patients, 83 and 24 patients with limited-stage disease (LD) and 123 and 37 patients with extensive-stage disease (ED) were assigned to the high- and low-CXI groups, respectively. Only one of 24 patients (4.2%) with LD in the low-CXI group achieved a complete response (CR), whereas 30 of 83 patients (36.1%) with LD in the high-CXI group achieved CRs (p = 0.004). More low-CXI patients required early discontinuation of treatment because of treatment-related toxicity compared to the high-CXI patients (37.5% vs. 16.9%, respectively, p = 0.030, for LD patients; 27.0% vs. 11.4%, respectively, p = 0.019, for ED patients). The median progression-free survival (PFS) and overall survival (OS) were significantly shorter in the low-CXI group than the high-CXI group (6.3 vs. 11.1 months and 7.5 vs. 20.6 months, respectively, both p < 0.001 for LD patients; 2.9 vs. 6.3 months and 5.8 vs. 12.8 months, respectively, both p < 0.001, for ED patients). On multivariate analysis, low-CXI status was an independent poor prognostic factor for both PFS and OS regardless of the tumor stage. Conclusion A low CXI was associated with treatment intolerance, poor treatment response rate, and poor prognosis in SCLC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08300-x.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
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Tapan U, Furtado VF, Qureshi MM, Everett P, Suzuki K, Mak KS. Racial and Other Healthcare Disparities in Patients With Extensive-Stage SCLC. JTO Clin Res Rep 2021; 2:100109. [PMID: 34589974 PMCID: PMC8474393 DOI: 10.1016/j.jtocrr.2020.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Systemic treatment with chemotherapy is warranted for patients with extensive-stage SCLC (ES-SCLC). The objective of this study was to determine whether racial and other healthcare disparities exist in receipt of chemotherapy for ES-SCLC. METHODS Utilizing the National Cancer Database, 148,961 patients diagnosed to have stage IV SCLC from 2004 to 2016 were identified. Adjusted ORs with 95% confidence intervals (95% CIs) were computed for receipt of chemotherapy using multivariate logistic regression modeling. Cox regression modeling was used to perform overall survival analysis, and adjusted hazard ratios were calculated. RESULTS A total of 82,592 patients were included, among which chemotherapy was not administered to 6557 (7.9%). Higher education, recent year of diagnosis, and treatment at more than one facility were associated with increased odds of receiving chemotherapy. Factors associated with a decreased likelihood of receiving chemotherapy were increasing age, race, nonprivate insurance, and comorbidities. On multivariate analysis, black patients had lower odds of receiving chemotherapy compared with white patients (adjusted OR, 0.85; 95% CI: 0.77-0.93, p = 0.0004). Furthermore, black patients had better survival compared with white patients (adjusted hazard ratio, 0.91; 95% CI: 0.89-0.94, p = 0.91). The 1-year survival (median survival) for black and white patients was 31.7% (8.3 mo) and 28.6% (8 mo), respectively. CONCLUSIONS Black patients with ES-SCLC were less likely to receive chemotherapy, as were elderly, uninsured, and those with nonprivate insurance. Further studies are required to address underlying reasons for lack of chemotherapy receipt in black patients with ES-SCLC and guide appropriate interventions to mitigate disparities.
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Affiliation(s)
- Umit Tapan
- Department of Hematology and Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Vanessa Fiorini Furtado
- Department of Hematology and Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Muhammad Mustafa Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Peter Everett
- Department of Hematology and Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kei Suzuki
- Department of Thoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kimberley S. Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Bahij R, Jeppesen SS, Olsen KE, Halekoh U, Holmskov K, Hansen O. Outcome of treatment in patients with small cell lung cancer in poor performance status. Acta Oncol 2019; 58:1612-1617. [PMID: 31282251 DOI: 10.1080/0284186x.2019.1637934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Patients with small cell lung cancer (SCLC) with poor performance status (PS) especially in the elderly may not benefit from chemotherapy. The aim of this study was to compare survival of treated patients with PS 3-4 with untreated patients.Material and methods: We reviewed the medical records and pathology data for 448 patients diagnosed with small cell carcinoma from 2010 to 2015 and selected all patients in PS 3-4 for review.Results: A total of 87 patients fulfilled the inclusion criteria. Of these, 53 (61%) received chemotherapy (CT), while 34 (39%) did not. The median overall survival (OS) was 5.1 months for the treated patients and 0.7 month for the untreated (p < .001). Multivariate analysis identified lack of treatment with chemotherapy, extensive disease, and PS 4 as independent factors associated with poor prognosis, while age and gender were not. Also, patients with aged ≥70 years who had extended disease had significant improved OS when treated with CT. However, the chance of being treated with CT was significantly influenced by age.Conclusion: CT was associated with improved survival in patients with SCLC with PS 3-4 independent of age and stage of disease. Neither ED, high age, nor poor PS should be used as criteria for omitting CT.
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Affiliation(s)
- Rana Bahij
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Ege Olsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ulrich Halekoh
- Institute of Epidemiology, Biostatics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Karin Holmskov
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Yang Y, Yuan G, Zhan C, Huang Y, Zhao M, Yang X, Wang S, Lin Z, Zheng S, Lu T, Guo W, Wang Q. Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer. J Cancer 2019; 10:5404-5412. [PMID: 31632485 PMCID: PMC6775691 DOI: 10.7150/jca.31202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 07/28/2019] [Indexed: 12/15/2022] Open
Abstract
Surgery combined with chemotherapy/radiotherapy is recommended for early stage small cell lung cancer (SCLC); however, the role of surgery in the multimodality treatment of advanced disease remains controversial. The clinical data of patients between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. The surgery group included 998 patients with stage IIB-IIIC. A matched non-surgery group (n = 2994) was generated by propensity score matching. The Kaplan-Meier method and log-rank tests were used for survival analyses. Univariate and multivariate analyses were used to identify significant prognostic factors. After matching, there were no significant differences between the two groups in race, age, sex, T classification, N classification, TNM stage, marital status, primary sites, and origin record NAACCR Hispanic Identification Algorithm (NHIA). The surgery group showed better overall survival and cancer-specific survival than the non-surgery group. Univariate and multivariate analyses showed that therapy methods, age, sex, T classification, and N classification were independent prognostic predictors for stage IIB-IIIC SCLC (all P < 0.05). Stratified analyses showed that survival outcomes favored surgery in any age groups, men and women, any T classification except T3, and N0-2 but not N3 compared with non-surgical treatment. The survival differences favored surgery in stage IIB and IIIA SCLC, although they were not significant in stage IIB and IIIC SCLC. Therefore, surgery was associated with improved survival in stage IIB and IIIA SCLC, but not in stage IIIB and IIIC SCLC.
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Affiliation(s)
- Yong Yang
- Department of Cardio-Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Thoracic Surgery, Suzhou Hospital affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China
| | - Guangda Yuan
- Department of Thoracic Surgery, Suzhou Hospital affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China.,Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiying Zheng
- Department of Cardio-Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Reed M, Patrick C, Quevillon T, Walde N, Voutsadakis IA. Prediction of hospital admissions and grade 3-4 toxicities in cancer patients 70 years old and older receiving chemotherapy. Eur J Cancer Care (Engl) 2019; 28:e13144. [PMID: 31429128 DOI: 10.1111/ecc.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 12/19/2022]
Abstract
AIM To predict chemotherapy toxicity and hospitalisations in elderly patients using clinical and laboratory parameters. METHODS Records of cancer patients 70 years old or older who received adjuvant chemotherapy or first-line chemotherapy for a cancer in a single centre were reviewed. Factors associated with hospitalisations, grade 3-4 toxicities and dose reductions during treatment were evaluated. RESULTS A total of 275 patients included in the study. Most patients (53.8%) were 70 to 75 years old. One hundred and five patients (38.2%) had a hospital admission during or within a month after their chemotherapy treatment. The only factor associated with admissions in the multivariate analysis was ECOG performance status (PS) >1 (p = .008, odds ratio 2.66, 95% CI: 1.28-5.53) and hypoalbuminaemia approached significance. Grade 3 and 4 toxicities were associated with a lower creatinine clearance in the multivariate analysis (p = .01, odds ratio 0.98, 95% CI: 0.97-1.0), and dose reductions were associated with metastatic stage (p = .03, odds ratio 1.88, 95% CI: 1.05-3.35). A combined index with all four parameters was associated with all three outcomes of interest. CONCLUSION ECOG PS, stage, albumin and creatinine clearance may be predictive of hospital admissions, grade 3-4 toxicities and dose reduction rates in cancer patients 70 years old and older receiving chemotherapy.
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Affiliation(s)
- Melissa Reed
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
| | - Caitlyn Patrick
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
| | - Travis Quevillon
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
| | - Natalie Walde
- Clinical Trials Unit, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
| | - Ioannis A Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada.,Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Povsic M, Enstone A, Wyn R, Kornalska K, Penrod JR, Yuan Y. Real-world effectiveness and tolerability of small-cell lung cancer (SCLC) treatments: A systematic literature review (SLR). PLoS One 2019; 14:e0219622. [PMID: 31318909 PMCID: PMC6638917 DOI: 10.1371/journal.pone.0219622] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES SCLC makes up approximately 15% of all lung carcinomas and is characterized by relatively aggressive spread and poorer prognosis compared to other lung cancers. Treatment options are limited, and their efficacy in randomized trials is poor, whilst outcomes in clinical practice remain unclear. The aim of this study was to assess the real-world effectiveness and tolerability of SCLC treatments. METHODS An SLR was conducted across nine databases accessed through OVID, capturing observational, non-randomized studies published between 01/2006-11/2018. In total, 554 abstracts were retrieved and systematically screened for eligibility. The eligible publications included effectiveness and tolerability data from adult SCLC patients (at any line of therapy). Additional grey literature searches were conducted. RESULTS Forty-three publications were included in this review-data from first-line therapies were captured most often (n = 32), while data from second (n = 14) and third line (n = 7) and beyond (n = 7) were less frequent. The publications reported primarily on chemotherapy/radiotherapy. The majority of publications lacked robustness and only 14/43 conducted statistical analyses or controlled for bias. Median OS for the largest SCLC populations were 9.6 months at first line (n = 23,535) and 4.9 months at second line (n = 254) for treatment with chemotherapy, and 4.7 months at third line (n = 120) for predominantly platinum-based chemotherapy or cyclophosphamide/adriamycin/vincristine. Hematologic toxicities (such as neutropenia, thrombocytopenia and anemia) were the most frequently reported TRAEs (n = 9). CONCLUSIONS Real-world treatment effectiveness and tolerability data were fragmented and inconsistently reported, and available publications were primarily of poor quality and lacked statistical analyses. This SLR showed limited treatment options and poor OS in SCLC, with no treatment option being clearly superior. TRAEs additionally increased the burden of this already challenging disease. Recent data suggest real-world outcomes are even poorer that those reported in clinical trials, and that novel therapies are needed to offer new treatment options for patients.
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Affiliation(s)
- Manca Povsic
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - Robin Wyn
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - John R. Penrod
- Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ, United States of America
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Fjose M, Eilertsen G, Kirkevold M, Grov EK. "Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system. BMC Health Serv Res 2018; 18:745. [PMID: 30268149 PMCID: PMC6162914 DOI: 10.1186/s12913-018-3548-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient.
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Affiliation(s)
- Marianne Fjose
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Postboks 7030, 5020, Bergen, Norway.
| | - Grethe Eilertsen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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10
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Voutsadakis IA. Clinical tools for chemotherapy toxicity prediction and survival in geriatric cancer patients. J Chemother 2018; 30:266-279. [DOI: 10.1080/1120009x.2018.1475442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ioannis A. Voutsadakis
- Division of Medical Oncology, Sault Area Hospital, Sault Ste Marie, Ontario, Canada
- Department of Internal Medicine, Sault Area Hospital, Sault Ste Marie, Ontario, Canada
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Damhuis R, Widder J, Senan S. Population-based Results of Chemoradiotherapy for Limited Stage Small Cell Lung Cancer in The Netherlands. Clin Oncol (R Coll Radiol) 2018; 30:17-22. [DOI: 10.1016/j.clon.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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12
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Damhuis RAM, Senan S, Belderbos JS. Usage of Prophylactic Cranial Irradiation in Elderly Patients With Small-cell Lung Cancer. Clin Lung Cancer 2017; 19:e263-e267. [PMID: 29208355 DOI: 10.1016/j.cllc.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/22/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) reduces the risk of overt brain metastases in patients with small-cell lung cancer (SCLC) and is currently recommended in guidelines for both limited and extensive disease. Given the concerns about the greater frequency of neurologic side effects in elderly patients, we studied the association among age, PCI usage, and survival for SCLC patients in the Netherlands. PATIENTS AND METHODS Data from the Netherlands Cancer Registry for patients diagnosed with SCLC from 2009 to 2013 were queried. Separate analyses were performed for patients with stage I to III, treated with chemoradiotherapy (n = 1684) and patients with stage IV, treated with chemotherapy or chemoradiotherapy (n = 3481). Patients with brain metastasis at diagnosis were excluded. RESULTS For patients with stage I to III, the overall PCI usage rate was 74%, and the rate decreased with age, from 78% for patients aged 18 to 59 years to 66% for patients aged ≥ 80 years. For patients with stage IV, the overall PCI usage rate was 41% and decreased with age, from 46% for patients aged 18 to 59 years to 23% for patients aged ≥ 80 years. Gender and socioeconomic status did not affect the PCI rates. For patients aged < 70 years and treated with PCI, the median survival was 45, 24, and 12 months for stage I and II, III, and IV, respectively. For patients aged ≥ 70 years treated with PCI, the corresponding survival duration was 33, 17, and 10 months. CONCLUSION In the Dutch population, PCI usage rates were fairly high but were significantly lower for elderly patients.
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Affiliation(s)
- Ronald A M Damhuis
- Department of Research, Comprehensive Cancer Organization, Utrecht, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jose S Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Abstract
INTRODUCTION An important step in improving research and care for the oldest patients with lung cancer is analyzing current data regarding diagnostic work-up, treatment choices, and survival. METHODS We analyzed data on lung cancer from the Netherlands Cancer Registry (NCR-IKNL) regarding diagnostic work-up, treatment, and survival in different age categories; the oldest old (≥85 years of age) versus those aged 71-84 (elderly) and those aged ≤70 years (younger patients). RESULTS 47,951 patients were included in the 2010-2014 NCR database. 2196 (5%) patients were aged ≥85 years. Histological diagnosis was obtained significantly less often in the oldest old (38%, p < 0.001), and less standard treatment regimen was given (8%, p < 0.001) compared to elderly and younger patients. 67% of the oldest old received best supportive care only versus 38% of the elderly and 20% of the younger patients (p < 0.001). For the oldest old receiving standard treatment, survival rates were similar in comparison with the elderly patients. In the oldest old, no survival differences were found when comparing standard or adjusted regimens for stage I and IV NSCLC; for stage III, oldest old receiving standard treatment had longer survival. No oldest old patients with stage II received standard treatment. CONCLUSION Clinicians make limited use of diagnostics and invasive treatment in the oldest old; however, selected oldest old patients experienced similar survival rates as the elderly when receiving some form of anticancer therapy (standard or adjusted). More research is needed to further develop individualized treatment algorithms.
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Halvorsen TO, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, Bremnes RM, Kaasa S, Grønberg BH. Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer. Acta Oncol 2016; 55:1349-1354. [PMID: 27549509 DOI: 10.1080/0284186x.2016.1201216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. MATERIAL AND METHODS We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. RESULTS In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. CONCLUSION Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
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Affiliation(s)
- Tarje Onsøien Halvorsen
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Sundstrøm
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd T. Brustugun
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paal Brunsvig
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ulf Aasebø
- Department of Pulmonology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Roy M. Bremnes
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn H. Grønberg
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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15
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Liang X, Gu J, Yu D, Wang G, Zhou L, Zhang X, Zhao Y, Chen X, Zheng S, Liu Q, Cai L, Cui J, Li W. Low-Dose Radiation Induces Cell Proliferation in Human Embryonic Lung Fibroblasts but not in Lung Cancer Cells: Importance of ERK1/2 and AKT Signaling Pathways. Dose Response 2016; 14:1559325815622174. [PMID: 26788032 PMCID: PMC4710120 DOI: 10.1177/1559325815622174] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Hormesis and adaptive responses are 2 important biological effects of low-dose ionizing radiation (LDR). In normal tissue, LDR induces hormesis as evinced by increased cell proliferation; however, whether LDR also increases tumor cell proliferation needs to be investigated. In this study, cell proliferation was assayed by total cell numbers and the Cell Counting Kit 8 assay. Mitogen-activated protein kinases (MAPK)/extracellular signal-regulated kinase (ERK) and phosphatidylinositol 3′ -kinase(PI3K)-Akt (PI3K/AKT) phosphorylation were determined by Western blot analysis. Human embryonic lung fibroblast 2BS and lung cancer NCI-H446 cell lines were irradiated with LDR at different doses (20-100 mGy). In response to 20 to 75 mGy X-rays, cell proliferation was significantly increased in 2BS but not in NCI-H446 cells. In 2BS cells, LDR at 20 to 75 mGy also stimulated phosphorylation of MAPK/ERK pathway proteins including ERK, MEK, and Raf and of the PI3K/AKT pathway protein AKT. To test whether ERK1/2 and AKT pathway activation was involved in the stimulation of cell proliferation in 2BS cells, the MAPK/ERK and PI3K/AKT pathways were inhibited using their specific inhibitors, U0126 and LY294002. U0126 decreased the phosphorylation of ERK1/2, and LY294002 decreased the phosphorylation of AKT; each could significantly inhibit LDR-induced 2BS cell proliferation. However, LDR did not stimulate these kinases, and kinase inhibitors also did not affect cell proliferation in the NCI-H446 cells. These results suggest that LDR stimulates cell proliferation via the activation of both MAPK/ERK and PI3K/AKT signaling pathways in 2BS but not in NCI-H446 cells. This finding implies the potential for applying LDR to protect normal tissues from radiotherapy without diminishing the efficacy of tumor therapy.
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Affiliation(s)
- Xinyue Liang
- Cancer Center, the First Hospital of Jilin University, Changchun, China; Department of Pediatrics, Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY, USA
| | - Junlian Gu
- Department of Pediatrics, Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY, USA
| | - Dehai Yu
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Guanjun Wang
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Lei Zhou
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Xiaoying Zhang
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Yuguang Zhao
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Xiao Chen
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Shirong Zheng
- Department of Pediatrics, Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY, USA
| | - Qiang Liu
- Tianjin Key Lab of Radiation and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Lu Cai
- Department of Pediatrics, Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY, USA
| | - Jiuwei Cui
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Wei Li
- Cancer Center, the First Hospital of Jilin University, Changchun, China
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16
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Survival patterns in lung and pleural cancer in Europe 1999–2007: Results from the EUROCARE-5 study. Eur J Cancer 2015; 51:2242-2253. [DOI: 10.1016/j.ejca.2015.07.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/09/2015] [Accepted: 07/20/2015] [Indexed: 12/11/2022]
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