Chemo Modifications Can Improve Quality of Life in Older Patients

Chemotherapy treatment can often come with side effects that decrease patients’ quality of life — especially for older adults with additional health conditions. However, recent research published in JAMA found that treatment modifications may make therapy more tolerable for patients with certain cancers.

“Older adults are disproportionately underrepresented in cancer trials that are used to establish treatment guidelines,” the researchers wrote. “This underrepresentation results in uncertainties about the standard-of-care treatments for older patients, including treatment safety and efficacy for older adults who have aging-related conditions.”

READ MORE: Older Adults Should Discuss Cancer Care Goals With Providers

The researchers analyzed data from 609 patients aged 70 or older (the average age was 77.2) with advanced cancer who had one or more impairments per a geriatric assessment. The most common cancer types were gastrointestinal cancers (228 patients; 37.4%) and lung cancer (174 patients; 28.6%). All patients were starting a palliative (not intended for cure) chemotherapy regimen.

Study highlights:

  • Chemotherapy can diminish quality of life for older patients with cancer, but recent research suggests modified treatments may improve tolerability.
  • Data from 609 patients aged 70 or older with advanced cancer showed that modified chemotherapy regimens were associated with reduced rates of severe side effects or decreased ability to function.
  • Modified treatments did not tend to compromise clinical outcomes and were linked to a lower risk of functional decline, particularly in gastrointestinal cancer patients.
  • Patients and clinicians should consider these findings when devising treatment plans, though further research in the field is needed.

A total of 281 (46.1%) patients received a modified treatment regimen, which could consist of a lower dose, a different treatment schedule or both.

While the majority of patients (405; 66.5%) experienced a grade 3, 4 or 5 side effect — indicating moderate, severe or fatal toxicity, respectively — the modified treatment regimens were associated with a reduced risk of these types of side effects.

The modified treatment regimens did not lead to poorer clinical outcomes, either, according to the researchers.

“Furthermore, our findings suggest that this primary treatment modification was associated with tolerability without compromising treatment efficacy,” they wrote. “This was determined through a composite adverse outcome, an endpoint that incorporated clinician-rated toxic effects, patient-reported functional decline, and six-month survival in one outcome measure.”

When broken down by disease type, a decreased risk of grades 3 through 5 toxicity was seen in patients with gastrointestinal cancers and other cancer types, but not for patients with lung cancer.

A total of 28% of patients experienced patient-reported functional decline, with patients who had primary treatment modification experiencing a 20% lower risk of functional decline compared to those who underwent standard-of-care therapy.

Additionally, the researchers did not observe a significant difference between treatment modifications and patients’ ability to perform instrumental activities of daily living, which are necessary everyday tasks, such as medication management, food preparation and cleaning, according to the National Institutes of Health.

“Given that an important treatment goal in the advanced cancer setting is to improve quality of life and patient physical function, this finding suggests that current treatment guidelines may not fit to this population,” the researchers wrote.

Looking ahead, the researcher said that clinicians and patients should use these findings when crafting appropriate treatment plans for older adults with comorbidities and advanced cancer. Additionally, they mentioned that more research is warranted in this field.

“Future trials are needed to confirm these findings, focusing on different cancer types, treatment regimens and specific types of treatment modifications to better understand and optimize cancer treatment decision-making in older adults with advanced cancer and aging-related conditions,” they wrote.
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