Elderly patients with invasive cervical carcinoma are less likely to receive aggressive treatment than younger patients, and are more likely to die from the disease, a new study shows.
Given increasing evidence that older patients tolerate radical hysterectomy and aggressive radiotherapy relatively well, the findings suggest physicians should not consider advanced age alone as a reason to rule out such treatment, the study’s lead author, Dr. Jason D. Wright of Washington University School of Medicine in St. Louis, told Reuters Health.Dr. Wright and his colleagues looked at 1582 patients treated between January 1, 1986 and July 31, 2003, 197 of whom (12.5%) were 70 or older. While 54% of patients younger than 70 had surgery, just 16% of older patients did.The difference was sharpest among women with stage IB and IIA disease, the researchers found. Seventy-five percent of younger women with this type of neoplasm were treated with radical surgical resection compared with 24% of the older women.Older women were also nine times more likely than younger patients to forego treatment completely. While the older patients had roughly double the risk of death compared to their younger counterparts, there was no association between age and recurrent or persistent disease after adjustment for tumor stage and histology and treatment.”There are definitely biases against giving these elderly patients aggressive treatments,” Dr. Wright noted, adding that older patients themselves tend to be less likely to want such treatment.”The discrepancy in treatment for women with cervical carcinoma is likely multifactorial and reflects both physician and patient preferences,” he and his colleagues write. “Given the fact that geriatric patients often tolerate treatment well, aggressive therapy for patients with cervical carcinoma should not be withheld based on age alone.”In an accompanying editorial, Dr. Cornelius O. Granai of Brown University in Providence, Rhode Island, writes: “The defrocked arbitrary mantra, too old for the best treatments after ‘that certain age’, is an example of ‘old thinking’ that now, thankfully, is at rest for lack of a priori foundation.”(Source: Cancer 2005;103:5-10,85-89: Reuters Health: Reuters Health: Anne Harding: Oncolink: January 2005.)