Fang Penny, He Weiguo, Gomez Daniel R, Hoffman Karen E, Smith Benjamin D, Giordano Sharon H, Jagsi Reshma, Smith Grace L
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):748-757. doi: 10.1016/j.ijrobp.2017.01.228. Epub 2017 Feb 1.
To examine the frequency of guideline-concordant cancer care in elderly patients, including "older" elderly (age ≥80 years).
Using the Surveillance, Epidemiology and End Results-Medicare dataset in patients aged ≥66 years diagnosed with nonmetastatic breast cancer (n=55,094), non-small cell lung (NSCLC) (n=36,203), or prostate cancer (n=86,544) from 2006 to 2011, chemotherapy, surgery, and radiation (RT) treatments were identified using claims. Pearson χ tested associations between age and guideline concordance.
Older patients were less likely to receive guideline-concordant curative treatment: in stage III breast cancer, receipt of postmastectomy RT (70%, 46%, and 21% in patients aged 66-79, 80-89, and ≥90 years, respectively; P<.0001); in stage I NSCLC, RT or surgery (89%, 80%, and 64% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage III NSCLC, RT or surgery plus chemotherapy (79%, 58%, and 27% in age 66-79, 80-89, and ≥90 years; P<.0001); and in intermediate/high-risk prostate cancer, RT or prostatectomy (projected life expectancy >10 years: 85% and 82% in age 66-69 and 70-75 years; and ≤10 years: 70%, 42%, and 9% in age 76-79, 80-89, and ≥90 years; P<.0001). However, older patients were more likely to receive guideline-concordant de-intensified treatment: in stage I to II node-negative breast cancer, hypofractionated postlumpectomy RT (9%, 16%, and 23% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I estrogen receptor-positive breast cancer, observation after lumpectomy (12%, 42%, and 84% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I NSCLC, stereotactic body RT instead of surgery (7%, 16%, and 25% in age 66-79, 80-89, and ≥90 years; P<.0001); and in lower-risk prostate cancer, no active treatment (25%, 54%, and 68% in age 66-79, 80-89, and ≥90 years; P<.0001).
Actual treatment of older elderly cancer patients frequently diverged from guidelines, especially in curative treatment of advanced disease. Results suggest a need for better metrics than existing guidelines alone to evaluate quality and appropriateness of care in this population.
研究老年患者（包括“高龄”老年人，即年龄≥80岁）接受符合指南的癌症治疗的频率。
利用监测、流行病学和最终结果-医疗保险数据集，纳入2006年至2011年期间诊断为非转移性乳腺癌（n = 55,094）、非小细胞肺癌（NSCLC）（n = 36,203）或前列腺癌（n = 86,544）且年龄≥66岁的患者，通过理赔记录确定化疗、手术和放疗（RT）治疗情况。采用Pearson χ检验年龄与指南一致性之间的关联。
老年患者接受符合指南的根治性治疗的可能性较小：在III期乳腺癌中，接受乳房切除术后放疗的比例分别为66 - 79岁患者70%、80 - 89岁患者46%、≥90岁患者21%（P <.0001）；在I期NSCLC中，接受放疗或手术的比例分别为66 - 79岁患者89%、80 - 89岁患者80%、≥90岁患者64%（P <.0001）；在III期NSCLC中，接受放疗或手术加化疗的比例分别为66 - 79岁患者79%、80 - 89岁患者58%、≥90岁患者27%（P <.0001）；在中/高危前列腺癌中，接受放疗或前列腺切除术（预期寿命>10年：66 - 69岁患者85%、70 - 75岁患者82%；预期寿命≤10年：76 - 79岁患者70%、80 - 89岁患者42%、≥90岁患者9%；P <.0001）。然而，老年患者接受符合指南的减强度治疗的可能性较大：在I至II期淋巴结阴性乳腺癌中，接受部分乳腺切除术后低分割放疗的比例分别为66 - 79岁患者9%、80 - 89岁患者16%、≥90岁患者23%（P <.0001）；在I期雌激素受体阳性乳腺癌中，接受乳房切除术后观察的比例分别为66 - 79岁患者12%、80 - 89岁患者42%、≥90岁患者84%（P <.0001）；在I期NSCLC中，接受立体定向体部放疗而非手术的比例分别为66 - 79岁患者7%、80 - 89岁患者16%、≥90岁患者25%（P <.0001）；在低危前列腺癌中，不接受积极治疗的比例分别为66 - 79岁患者25%、80 - 89岁患者54%、≥90岁患者68%（P <.0001）。
老年癌症患者的实际治疗情况常常与指南不一致，尤其是在晚期疾病的根治性治疗方面。结果表明，除现有指南外，还需要更好的指标来评估该人群的医疗质量和适宜性。
