Chemotherapy treatment frequently results in side effects that can diminish the quality of life for patients, particularly older adults with additional health issues. Nevertheless, a recent study published in JAMA indicates that making adjustments to the treatment approach could enhance its tolerability for individuals with specific types of cancer.
The researchers highlighted the underrepresentation of older adults in cancer trials, leading to uncertainties regarding the most suitable treatment approaches for this demographic. This knowledge gap includes concerns about treatment safety and efficacy for older patients with age-related conditions.
In their analysis, the researchers examined data from 609 patients aged 70 or above, with an average age of 77.2, who had advanced cancer along with impairments identified through a geriatric assessment. The most prevalent cancer types among the participants were gastrointestinal cancers (37.4%) and lung cancer (28.6%). All patients were commencing a palliative chemotherapy regimen.
Key findings from the study include:
- Modified chemotherapy regimens were linked to reduced rates of severe side effects and a decline in functional ability among older patients with advanced cancer.
- The adjusted treatments did not compromise clinical outcomes and were associated with a lower risk of functional deterioration, particularly in patients with gastrointestinal cancers.
- Patients and healthcare providers are encouraged to consider these insights when formulating treatment strategies, although further research is essential in this area.
Out of the 609 patients, 281 (46.1%) received modified treatment regimens, which could involve dosage reduction, a different treatment schedule, or both.
While a majority of patients (66.5%) encountered grade 3, 4, or 5 side effects indicating moderate to fatal toxicity levels, the modified treatment regimens were correlated with a decreased risk of such adverse effects.
The researchers also observed that the adjusted treatment regimens did not result in inferior clinical outcomes.
The study’s composite adverse outcome measure, which factored in toxic effects assessed by clinicians, patient-reported functional decline, and six-month survival, indicated that primary treatment modifications were associated with enhanced tolerability without sacrificing treatment effectiveness.
Notably, patients with gastrointestinal cancers and other types of cancer experienced a reduced risk of grades 3 to 5 toxicity with modified treatments, unlike those with lung cancer.
Approximately 28% of patients reported a decline in functional ability, with those undergoing primary treatment modifications having a 20% lower risk of functional decline compared to those following standard care.
Moreover, there was no significant disparity observed between treatment modifications and patients’ ability to carry out instrumental activities of daily living, as outlined by the National Institutes of Health.
Given the objective of enhancing quality of life and physical function in advanced cancer care, the researchers emphasized the necessity of tailoring treatment guidelines to better suit this patient population.
Moving forward, the researchers recommended that clinicians and patients take these findings into account when developing tailored treatment plans for older adults with comorbidities and advanced cancer. They also underscored the need for further research to validate these results and explore various aspects of cancer treatment decision-making in this demographic.