Elderly patients Undergo Less Treatment for Glioblastoma

A new study examining the patterns of treatment in older patients with glioblastoma multiforme (GBM) has found that age was the most significant factor in predicting whether a patient received treatment or not.

Researchers at the Memorial Sloan-Kettering Cancer Center (MSKCC, New York, NY, USA) used data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry to gather information on 4,137 on patients who were at least 65 years old and were diagnosed with GBM between 1994 and 2002. They evaluated the associations of demographic characteristics (age, gender, race, marital status, and residence in a metropolitan versus a non-metropolitan county) and comorbidities with the probability of undergoing surgery, radiation, and chemotherapy to treat the tumor.

The study showed that older age associated with lower odds of undergoing surgery, radiation, or chemotherapy. The median survival for elderly patients was only four months. The results also showed that 61% of the patients underwent surgery. Radiation was performed in 65% of patients, while only 10% underwent chemotherapy. Patients who were older, unmarried, and had additional health issues were less likely to receive radiation or chemotherapy within three months of diagnosis. The study also found that black patients had surgery less often than white patients; although the reasons for the difference in surgery rates between blacks and whites are not clear, the authors speculate that blacks may have been more likely to have health conditions that made them poor candidates for surgery, or may be more averse to having surgery than whites. The study was published in the December 2008 issue of the Annals of Neurology.

"Physicians may be concerned about increased toxic side effects or complications from treatment in elderly patients," said lead author Lauren Abrey, M.D., and colleagues of the department of neurology. "Another possibility is that elderly patients may decline more invasive and aggressive treatments because therapies are only palliative and may prolong life only for a short time."

GBM is the most common and most aggressive type of primary brain tumor, accounting for 52% of all primary brain tumor cases and 20% of all intracranial tumors. However, despite being the most prevalent form of primary brain tumor, GBMs occur in only 2-3 cases per 100,000 people in Europe and North America.

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Memorial Sloan-Kettering Cancer Center