Age no barrier to aggressive therapies.

Age no barrier to aggressive therapies

Physicians often think of the elderly as too fragile to take the harsh treatments ordinarily prescribed to stop a heart attack or knock back advanced cancer. However, two new studies dispel that myth, suggesting instead that many elderly people respond to aggressive treatment as vigorously as younger people.

Previous studies have shown that investigators often exclude older people from clinical trials of cancer drugs, perhaps because physicians fear that even when elderly cancer patients do receive chemotherapy, they often get lower doses than their younger counter-parts--a practice that may undermine treatment efficacy.

Kathy Christman of the Memorial-Sloan Kettering Cancer Institute in New York City and her colleagues at Wake Forest University in Winston-Salem, N.C., decided to take a hard look at the folklore surrounding treatment of metastatic breast cancer. They studied 170 women with advanced breast cancer who had been treated in five clinical trials between 1974 and 1989. The team compared patients age 70 and older with patients age 50 through 69 and with another group younger than 50.

A review of medical records showed that the three age groups barely differed from each other in terms of time to disease progression or length of survival. For example, women under 50 survived an average of 17.9 months after treatment, while those in the 70-plus group survived 14.2 months. There is no significant difference between those statistics, Christman says.

Furthermore, the toxic effects of chemotherapy were similar for all three age groups.

Rather than focus on age, oncologists should look at each patient's health status, the researchers suggest in the July 1 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. For example, heart attack victims of all ages may do worse if given certain heart-damaging cancer drugs, Christman notes.

Cancer treatment is not the only area in which the elderly may face medical bias. Doctors know that rapid administration of a clot-busting drug such as streptokinase can save the life of a person in the throes of a heart attack. Yet a 1991 study revealed that heart attack victims under the age of 75 are six times more likely than older patients to receive such drugs.

An analysis in the July 2 NEW ENGLAND JOURNAL OF MEDICINE now shows that people age 75 and older who receive streptokinase for heart attacks gain a survival edge over those who receive no clot-dissolving therapy.

Treatment with streptokinase involves some risks, such as excessive bleeding. Yet Lee Goldman of Harvard Medical School in Boston and his colleagues conclude that for older heart attack victims, the benefits of streptokinase therapy greatly outweigh the risks.

Taken together, the new findings suggest that doctors should reexamine their assumptions about the elderly. "One should not exclude patients from standard therapy because of age alone," Christman says.