Comorbidities more important than chronological age in the elderly

A retrospective analysis of data from two randomised controlled trials suggests that in the elderly the presence of comorbid conditions may be a more relevant selection criterion for treatment than chronological age. The effects of age and comorbid conditions are important factors in design of trials for chemotherapy of non—small-cell lung cancer (NSCLC), particularly for elderly patients. Chronological age is associated with age related conditions but physiological age, which takes chronic disease into account may be more relevant. This pooled analysis from the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada analysed data from patients with NSCLC in two prospective randomised trials of systemic adjuvant and palliative chemotherapy. Medical conditions and medications at baseline were scored using the Charlson comorbidity index (CCI). This validated score is weighted according to the influence of comorbidity on overall mortality. The analysis included 1255 patients, median age 61 years (range, 34 to 89 years) and 34% of patients were at least 65 years of age. Nearly one third had comorbid conditions. Twenty-five percent of patients had a CCIS of 1, and 6% had a CCIS of 2 or more. Results showed that 42% of the elderly patients had a CCIS equal to or greater than 1 compared with 26% of younger patients (P < 0.0001). The elderly were also more likely to have a PS of greater than 1, squamous histology, a time from diagnosis to randomisation of more than 6 months and to have received significantly lower median doses of chemotherapy. . Higher CCIS scores were also seen in males than females (35% and 21% respectively, p < 0.0001) and patients with squamous histology (36% and 29%, p = 0.001). Multivariate analysis showed that performance status, histology, stage and normal albumen were associated with a higher objective response rate. Age did not influence overall survival, but a CCIS of greater than 1 was associated with shorter survival. CCI or age were not associated with disease specific survival. The authors concluded that the elderly patients in these trials received less chemotherapy but had the same survival benefit as younger ones. Reference...