Background: Twenty percent of all newly diagnosed patients with small-cell lung cancer (SCLC) are >75 years. Elderly patients may show more toxicity due to co-morbidity. We evaluated motives for adherence to treatment guidelines, completion of treatment and toxicity. Patients and methods: Population-based data from patients aged ≥75 years and diagnosed with SCLC in 1997-2004 in The Netherlands were used (368 limited disease and 577 extensive disease). Additional data on co-morbidity (Adult Co-morbidity Evaluation 27), World Health Organisation performance status (PS), treatment, motive for no chemotherapy, adaptations and underlying motive and grade 3 or 4 toxicity were gathered from the medical records. Results: Forty-eight percent did not receive chemotherapy. The most common motives were refusal by the patient or family, short life expectancy or a combination of high age, co-morbidity and poor PS. Although only relatively fit elderly were selected for chemotherapy, 60%-75% developed serious toxicity, and two-thirds of all patients could not complete the full chemotherapy. Conclusions: We hypothesise that a better selection by proper geriatric assessments is needed to achieve a more favourable balance between benefit and harm.

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Keywords Elderly, Population-based, Small-cell lung cancer, Toxicity, Treatment tolerance
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Janssen-Heijnen, M.L.G, Maas, H.A.A.M, van de Schans, S.A.M, Coebergh, J.W.W, & Groen, H.J.M. (2011). Chemotherapy in elderly small-cell lung cancer patients: Yes we can, but should we do it?. Annals of Oncology, 22(4), 821–826. doi:10.1093/annonc/mdq448