We performed a chart review study to determine whether physicians provided less vigorous treatment for elderly patients with breast cancer than for younger patients. Seven hospitals, varying with respect to size, medical school affiliation, and patient socioeconomic status participated in this study. Patterns of breast cancer care were compared with a set of branching logic standards in the form of a criteria map. A chart-based comorbidity index was developed to control for the influence of coexisting diseases on cancer management. Logistic regression analysis of 374 breast cancer cases revealed that both patient age and comorbidity status significantly and independently affected treatment. Among stage I and II patients with no or very mild comorbid disease, 96% of those aged 50 to 69 years received appropriate surgery vs 83% of patients aged 70 years and older. We conclude that physicians may manage patients with this highly treatable disease according to chronologic age without regard for physiological condition and that this age bias may result in a less favorable prognosis than could be achieved using currently recommended therapy.

Patterns of care related to age of breast cancer patients

BACKGROUND

Colon carcinoma primarily affects older-aged persons 65 years and older. Seventy-five percent of the incident tumors affect persons in this age group. Because of their advanced age, older patients already may be coping with other concomitant major physical illnesses. This article documents preexisting diseases in older colon carcinoma patients at diagnosis and evaluates the effects of their comorbidity burden on early mortality.



METHODS

Prevalence of comorbid conditions was assessed by a retrospective medical records review of an age-stratified random sample of male and female patients aged 55-64 years, 65-74 years, and 75+ years (males, n = 799; females, n = 811). Data were collected on comorbidity by the National Institute on Aging (NIA) and National Cancer Institute (NCI) and merged with NCI Surveillance, Epidemiology, and End Results (SEER) tumor registry data.



RESULTS

Hypertension, high impact heart conditions, gastrointestinal problems, arthritis, and chronic obstructive pulmonary disease emerged as the most prominent comorbid conditions in the NIA/NCI SEER study sample. The prevalence of comorbidity in the number and type of conditions similar for both men and women (e.g., 40% of each gender had ≥ 5 comorbidities). Within 2 years of diagnosis, 28% (n = 454) of the patients had died. The number of comorbid conditions was significant in predicting early mortality in a model including age, gender, and disease stage (P = 0.0007). Certain comorbidities, classified as "current problem," added significantly to a basic model (e.g., heart problems, alcohol abuse, liver disease, and deep vein thrombosis).



CONCLUSIONS

Although disease stage at time of diagnosis of colon carcinoma is a crucial determinant of patient outcome, comorbidity increases the complexity of cancer management and affects survival duration. Cancer control and treatment research questions should address comorbidity issues pertinent to the age group primarily afflicted with colon carcinoma (i.e., the elderly). Cancer 1998;82:2123-2134. © 1998 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291097-0142%2819980601%2982%3A11%3C2123%3A%3AAID-CNCR6%3E3.0.CO%3B2-W

Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients : A population-based study

Background Children who survive acute lymphoblastic leukemia are at risk for leukemia-related or treatment-related complications, which can adversely affect survival and socioeconomic status. We determined the long-term survival and the rates of health insurance coverage, marriage, and employment among patients who had attained at least 10 years of event-free survival. Methods A total of 856 eligible patients were treated between 1962 and 1992 in 13 consecutive clinical trials. Survival rates, the cumulative risk of a second neoplasm, and selected indicators of socioeconomic status were analyzed for the entire group and for patients who did or did not receive cranial or craniospinal radiation therapy during initial treatment. Results Fifty-six patients had major adverse events, including 8 deaths during remission, 4 relapses, and 44 second neoplasms (41 of them radiation-related); most of the second neoplasms were benign or of a low grade of malignant potential. The risk of a second neoplasm was significa...

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Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia.

In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. The results are described in terms of the following QL dimensions: physical functioning (QL, general health), psychological functioning (overall emotional functioning, depression and anxiety, self-esteem), social functioning (education, employment, insurance, living situation, marital status and family), and sexual functioning. Factors related to survivors' QL are reported: demographics and illness- and treatment related variables. Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.

Quality of life in young adult survivors of childhood cancer

Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database.

In a study specifically addressing the age-stage relationship, the authors examined the distribution of 30,991 cancers by disease-stage versus patient-age at the time of diagnosis. For cancer of the bladder, breast, cervix, ovary and uterus (endometrium), a highly significant positive relationship was found between advancing stage and advancing age (P less than 0.001). For cancer of the kidney and stomach, the relationship held but was less significant (P less than 0.05). For colorectal cancer, no relationship was evident. For bronchial cancer there was a highly significant inverse relationship (P less than 0.001). After the site of origin of the cancer, the stage at the time of diagnosis was the next most important determinant for treatment and survival. These data emphasize the importance of periodic pelvic examination as a means of screening for asymptomatic cervical, ovarian, or other uterine (endometrial) cancer in elderly women. Also, the data support the importance of breast self-examination and mammography in screening for breast cancer in older women. The inverse relationship of age to stage in bronchial cancer suggests that screening by periodic chest roentgenograms and cytologic sputum examinations may be more appropriate for elderly than for younger populations in whom these screening methods have proved disappointing.

Cancer Stage‐to‐Age Relationship: Implications for Cancer Screening in the Elderly*

Unlike most cancers, lung carcinoma is more likely to be localized at the time of diagnosis in older age groups when compared to those who are middle-aged. In an attempt to explain this inverse age-stage relationship we studied 9062 histologically confirmed cases of lung carcinoma occurring from 1975 to 1984 obtained from the regional cancer registry for Kansas and western Missouri. They were analyzed according to histologic type, age, sex, and stage at diagnosis. The data suggest that the proportion of squamous cell carcinoma rises and that of adenocarcinoma and small cell undifferentiated carcinoma falls with increasing age. The proportion of staged lung carcinoma with local disease at the time of diagnosis increases with age. In males this trend occurred in all cell types except large cell undifferentiated carcinoma but was most significant for squamous cell carcinoma. Squamous cell carcinoma was the only group to show a significant trend among females. The rise in squamous cell and fall in small cell carcinoma may partially explain the increased prevalence of local stage disease with advancing age.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819870915%2960%3A6%3C1331%3A%3AAID-CNCR2820600628%3E3.0.CO%3B2-X

Lung carcinoma in the elderly population. Influence of histology on the inverse relationship of stage to age

Although the effects of treatment for childhood cancer on subsequent reproductive outcomes are unknown, they are often implicated as contributing to that outcome in a detrimental manner. In this study, 263 adult survivors of childhood cancer were compared with 369 adult sibling controls regarding their decisions to marry and have children. The survivors were more likely to report not marrying for health reasons. Although the long-term surivivors did not have significantly more documented or suspected infertility problems, they were less likely than controls to have been pregnant or involved with a pregnancy and were more likely to have been advised by a physician to avoid a pregnancy. However, when the frequency of birth defects among 253 offspring of the survivors was compared with the frequency of defents among 595 offspring of controls, the outcome of pregnancy among survivors and controls proved to equally favorable.

Decisions About Marriage and Family Among Survivors of Childhood Cancer

The natural history of acute leukemia in the elderly is not well understood. There is disagreement about the value of treatment other than by supportive measures. In this study, the survival predictive power of 9 variables was analyzed in 103 patients aged 70 or older for whom a bone-marrow cytologic diagnosis of acute leukemia had been made at a referral hospital during the 30-year period, 1947--1976. When given, treatment was uniformly conservative. Blood leukocyte and platelet counts and hematocrit values at the time of diagnosis, sex, treatment, and the calendar year of diagnosis were significant (P less than 0.01) predictors of survival duration. Initial hematologic measurements, presumably reflecting the degree of leukemic cell infiltration of the bone marrow, were the strongest predictors of survival, whereas leukemic cell type had no predictive power. Survival increased significantly (P less than 0.01) during the 30-year period of the study, possibly more attributable to improved supportive care than to specific antileukemic therapy. Apparently survival is at least partly determined at the time of diagnosis, and conservative therapy often may be beneficial rather than detrimental.

Survival in the elderly with acute leukemia.

7 out of 39 patients with pernicious anemia developed 9 different neoplasms during a period of 3–20 years after the diagnosis of pernicious anemia. These primary neoplasms originated from the lymph no

Frederick F. Holmes

Papers

Cancer Stage‐to‐Age Relationship: Implications for Cancer Screening in the Elderly*

Lung carcinoma in the elderly population. Influence of histology on the inverse relationship of stage to age

Decisions About Marriage and Family Among Survivors of Childhood Cancer

Survival in the elderly with acute leukemia.

A Possible Association of Pernicious Anemia with Neoplasia