The Journal of Clinical Oncology has featured a study which concludes that older patients have more adverse events during chemotherapy, independent of co-morbidity.

Researchers evaluated chemotherapy use and adverse events (AEs) for advanced-stage, non–small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age.

A total of 1,371 patients with newly diagnosed, stages IIIB and IV NSCLC were included in the study. The following results were reported:

• Of 1,371 patients, 58% (95% CI, 55% to 61%) received chemotherapy and 35% (95% CI, 32% to 38%) had AEs.
• Pre-treatment medical event rates were 18.6% for patients younger than 55 years and were only 9.2% for those age 75 years and older (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91). In contrast, older adults were more likely to have AEs during chemotherapy. The adjusted rate ratios compared with age younger than 55 years were 1.70 for 65- to 74-year-olds (95% CI, 1.19 to 2.43) and 1.34 for those age 75 years and older (95% CI, 0.90 to 2.00).

The authors also concluded that “Because older patients have at least as many disease symptoms as younger patients, a logical consequence of lower treatment rates is more disease symptoms and worse quality of life for the oldest patients.
An unanswered question is whether the increased AEs associated with chemotherapy among the oldest patients who received chemotherapy was offset by improvement in their disease symptoms to provide a net positive effect on quality of life. Future quantifications of quality of life and survival outcomes will be important contributions to a fuller assessment of this possibility.”