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    Impact of Age on Treatment and Survival in Lung Cancer

    A recent study shows that many doctors discriminate against older lung cancer patients by failing to appropriately diagnose their cancer and provide treatments such as surgery, even when those patients are likely to respond well to treatment.

    Michael Peake, MD and his colleagues from the Royal College of Physicians in London, conducted the study on behalf of 47 hospitals that contributed to the research. Dr. Peake presented results at the 96th International Conference of the American Thoracic Society in Toronto.

    Dr. Peake explained that most people are around the age of 70 when they are diagnosed with lung cancer. Surgery provides the only real hope of long-term survival or "cure" for these patients, although other treatments have been successful in smaller numbers of patients. Previous research has shown that age alone does not determine whether or not a given treatment will be successful.

    Nevertheless, Dr. Peake and his colleagues were concerned by other studies that revealed older patients received less aggressive treatment than younger lung cancer patients. Acknowledging that other factors could be responsible for this (for example, the older patients may be sicker in general or have more advanced disease), they set out to determine to what extent are decisions regarding treatment of patients with lung cancer influenced purely by age?

    The news was not good. "Older patients with exactly the same extent and type of lung cancer, prognostic factors and co-existing diseases were being less
    actively treated," said Dr. Peake.

    The researchers collected data on 1652 consecutive patients treated at 47 hospitals in the United Kingdom and divided these patients into three groups according to age -- those less than 65 years of age, those 65-74 years of age and those 75 and over.

    All areas of the older patients' care suffered, starting with the quality of their diagnosis. Dr. Peake explained that correctly diagnosing the type of lung cancer the patient has is critical to the proper selection of treatment. He said that this usually requires histological confirmation, which is an examination of a sample of the cancerous tissue in a pathology laboratory. The study showed that this was not done in seven percent of the patients less than 65. But that figure almost doubled in the next age group with 13 percent of patients aged 65-74 and 19 percent of patients 75 or older, having histological confirmation of their cancer.

    When Dr. Peake and his colleagues looked at those patients most likely to respond well to treatment, he found that in the younger age group 37 percent of patients received surgery while 24 percent of the middle group and only 15 percent of the oldest patients received surgery. The number of patients that were given the only real chance at long-term survival in the oldest group was less than half of that in the youngest group -- and these were all patients that would probably have done well with surgery.

    This negligence translated into a higher death rate for the older patients as well. Again, when studying the group of patients most likely to benefit from treatment, at six months 76 percent of the youngest patients were still alive compared with 67 percent of the patients in the middle group and only 58 percent of the oldest patients.

    "Many physicians seem to assume that older patients have a worse prognosis and deny them access to a surgeon or oncologist," Dr. Peake said. "Some physicians may feel it's not worthwhile to treat these patients because of the poor overall survival statistics. And older patients may not wish to go through what they perceive as the traumas of such treatments, although their decision often is very dependent on the knowledge and enthusiasm of the doctor involved."



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