TY - JOUR
T1 - Chemotherapy-associated toxicity in a large cohort of elderly patients with non-small cell lung cancer
AU - Hardy, Dale
AU - Cormier, Janice N.
AU - Xing, Yan
AU - Liu, Chih Chin
AU - Xia, Rui
AU - Du, Xianglin L.
PY - 2010/1
Y1 - 2010/1
N2 - BACKGROUND: The objective of this study was to examine the risks for short-term (≤3 months) and long-term (>3 months) chemotherapy-associated toxicities in a large population-based cohort of patients with non-small cell lung cancer from 1991 to 2002. METHODS: The population consisted of 41,361 men and 30,804 women ≥65 years identified from the Surveillance, Epidemiology, and End Results-Medicare-linked database. The incidence of 50 toxicity-associated end points was calculated for 14 chemotherapy agents. Short- and long-term toxicities with a ≥2-fold increase in incidence compared with the no-chemotherapy group were defined as chemotherapy-associated toxicities. Hazard ratios and 95% confidence intervals for the risk of toxicity were calculated for the four most common chemotherapy agents for non-small cell lung cancer: cisplatin/carboplatin, paclitaxel, vinorelbine/vinblastine, and gemcitabine. RESULTS: The most common short-term toxicities (9.2-60%) included acute anemia, nausea, and neutropenia. The most common long-term toxicities (15-37%) included acute anemia, respiratory failure, pulmonary fibrosis, dehydration, neutropenia, nausea, and fever. Multivariate analysis for selected chemotherapies demonstrated that after adjusting for other risk factors and confounders, some short-term toxicities became nonsignificant; however, almost all long-term toxicities remained significant. Long-term toxicity increased over time and was more likely in women, minority populations, those with fewer baseline comorbidities, and across disease stages. CONCLUSIONS: The administration of various chemotherapy agents for non-small cell lung was associated with a number of short- and long-term toxicities. The projected survival benefits of chemotherapy must be weighed against the risk of long-term toxicities.
AB - BACKGROUND: The objective of this study was to examine the risks for short-term (≤3 months) and long-term (>3 months) chemotherapy-associated toxicities in a large population-based cohort of patients with non-small cell lung cancer from 1991 to 2002. METHODS: The population consisted of 41,361 men and 30,804 women ≥65 years identified from the Surveillance, Epidemiology, and End Results-Medicare-linked database. The incidence of 50 toxicity-associated end points was calculated for 14 chemotherapy agents. Short- and long-term toxicities with a ≥2-fold increase in incidence compared with the no-chemotherapy group were defined as chemotherapy-associated toxicities. Hazard ratios and 95% confidence intervals for the risk of toxicity were calculated for the four most common chemotherapy agents for non-small cell lung cancer: cisplatin/carboplatin, paclitaxel, vinorelbine/vinblastine, and gemcitabine. RESULTS: The most common short-term toxicities (9.2-60%) included acute anemia, nausea, and neutropenia. The most common long-term toxicities (15-37%) included acute anemia, respiratory failure, pulmonary fibrosis, dehydration, neutropenia, nausea, and fever. Multivariate analysis for selected chemotherapies demonstrated that after adjusting for other risk factors and confounders, some short-term toxicities became nonsignificant; however, almost all long-term toxicities remained significant. Long-term toxicity increased over time and was more likely in women, minority populations, those with fewer baseline comorbidities, and across disease stages. CONCLUSIONS: The administration of various chemotherapy agents for non-small cell lung was associated with a number of short- and long-term toxicities. The projected survival benefits of chemotherapy must be weighed against the risk of long-term toxicities.
KW - Chemotherapy
KW - Comorbidities
KW - Non-small cell lung cancer
KW - Toxicity
KW - Tumor stage
KW - Years of diagnosis
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U2 - 10.1097/JTO.0b013e3181c0a128
DO - 10.1097/JTO.0b013e3181c0a128
M3 - Article
C2 - 19884853
AN - SCOPUS:84868187801
SN - 1556-0864
VL - 5
SP - 90
EP - 98
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 1
ER -