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This Week in the British Medical Journal: Jul 18, 2011

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In the British Medical Journal this week, researchers in New York, Massachusetts, and Texas present findings from a study of survival rates and adverse events in elderly lung cancer patients receiving postoperative adjuvant chemotherapy. The researchers studied 3,324 patients older than 65, with resected stages II-IIIA lung cancer — 21 percent of the patients received platinum-based chemotherapy while the rest did not receive chemotherapy. Treatment was associated with improved survival, and was beneficial among patients treated with or without radiation therapy, the authors write. However, chemotherapy was not beneficial for patients over 80, and was also associated with an increased risk for serious adverse events in all patients.

In a related editorial, the University of Lyon's Béatrice Fervers says that age alone is not a contraindication to chemotherapy treatment in elderly lung cancer patients, and that it's important to consider a patient's comorbidities and performance status along with age. The toxicity of platinum-based chemotherapy remains a concern for older patients, and the presence of comorbid conditions in these patients are associated with poorer survival, Fervers says. Therefore, the management of elderly patients should start with a "comprehensive assessment of comorbidities and performance status," and should take a multidisciplinary approach, she adds. More research is needed to understand the impact of treatment-related adverse effects on the elderly patient's quality of life, Fervers says, and subgroups of elderly patients should be incorporated into future lung cancer trials.

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