Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy

Abstract Aim of the study To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other...

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Bibliographic Details
Published in:European journal of cancer (1990) 2010-08, Vol.46 (12), p.2225-2234
Main Authors: Grønberg, Bjørn H, Sundstrøm, Stein, Kaasa, Stein, Bremnes, Roy M, Fløtten, Øystein, Amundsen, Tore, Hjelde, Harald H, Plessen, Christian von, Jordhøy, Marit
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Carboplatin
Carboplatin - administration & dosage
Carcinoma, Non-Small-Cell Lung - drug therapy
Carcinoma, Non-Small-Cell Lung - mortality
Comorbidity
Deoxycytidine - administration & dosage
Deoxycytidine - analogs & derivatives
Disease-Free Survival
Female
Gemcitabine
Hematologic Diseases - chemically induced
Hematology, Oncology and Palliative Medicine
Humans
Lung Neoplasms - drug therapy
Lung Neoplasms - mortality
Male
Medical sciences
Middle Aged
Neutropenia - mortality
Neutropenic infection
Pemetrexed
Pharmacology. Drug treatments
Predictive factors
Prognostic factors
Quality of Life
Surveys and Questionnaires
Thrombocytopenia - mortality
Treatment outcome
Tumors
Young Adult
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Summary:Abstract Aim of the study To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other patients during treatment. Patients and methods Patients enrolled onto a phase III trial comparing pemetrexed/carboplatin with gemcitabine/carboplatin as first-line therapy of stage IIIB/IV NSCLC were analysed. Eligible patients had performance status 0–2 and adequate kidney/liver/bone-marrow function. Comorbidity was assessed from hospital medical records using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Toxicity was graded using the CTCAE v3.0 and the patients reported HRQoL on the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30/LC13. Results Data from 402 of the 436 of the patients enrolled onto the phase III trial were analysed. The patients with severe comorbidity had similar survival as other patients (6.9 versus 8.1 months; p = .34), similar frequency of neutropenia (48% versus 42%; p = .16), but experienced more neutropenic fevers (12% versus 5%; p = .012) and deaths from neutropenic infections (3% versus 0%; p = .027). They had more thrombocytopenia (46% versus 36%; p = .03), but not more thrombocytopenic bleedings (3% versus 4%; p = .65). In general, the patients with severe comorbidity reported poorer HRQoL, but not significantly more deterioration of HRQoL. Conclusions The results from our study suggest that patients with advanced NSCLC who have severe co-existing disorders benefit from and tolerate platinum-doublet chemotherapy as well as other patients. They do, however, appear to have a higher risk of acquiring infections when neutropenic.
ISSN:0959-8049
1879-0852
DOI:10.1016/j.ejca.2010.04.009