Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma

Restricted access

Object

This study was undertaken to evaluate the association between age at diagnosis, patterns of care, and outcome among elderly individuals with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM).

Methods

Using the Surveillance, Epidemiology and End Results database, the authors identified 1753 individuals with primary GBM and 205 individuals with primary AA (diagnosed between June 1991 and December 1999) who were 66 years and older and whose records were linked to Medicare information. To facilitate gathering of prediagnosis comorbidity and postdiagnosis treatment information, only those individuals were included who had the same Medicare coverage for 6 months before and 12 months after diagnosis. The odds of undergoing various combinations of treatments and the associations with outcome were calculated by tumor type and age and adjusted by various predictors.

Results

Age was not associated with treatment differences in individuals with AA. Very elderly individuals (≥ 75 years old) with GBM were more likely to have biopsy only (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78–3.59), surgery only (OR 1.47, 95% CI 1.15–1.87), or biopsy and radiation (OR 1.39, 95% CI 1.07–1.82) and were less likely to receive multimodal therapy. Regardless of patient age or lesion histological characteristics, survival was decreased in patients treated with biopsy only. Individuals with GBM who had surgery only or biopsy and radiation had worse outcomes than individuals treated with surgery and radiation. There were no differences in survival by lesion histological characteristics. Very elderly individuals with malignant astrocytomas were more likely to receive limited treatment (most pronounced in individuals with GBM). Survival variation correlated with treatment combinations.

Conclusions

These findings suggest that in clinical neurooncology patient age is associated with not receiving effective therapies and hence worse prognosis.

Abbreviations used in this paper: AA = anaplastic astrocytoma; CI = confidence interval; GBM = glioblastoma multiforme; HMO = health maintenance organization; HR = hazard ratio; ICD-9-CM = International Classification of Diseases, Ninth Version, Clinical Modification; ICD-O-3 = ICD for Oncology, Third Edition; MED-PAR = Medicare Provider Analysis and Review; NCH = National Claims History; OR = odds ratio; OUTSAF = Outpatient Standard Analytical File; SEER = Surveillance, Epidemiology, and End Results.

Article Information

Address correspondence to: Jill S. Barnholtz-Sloan, Ph.D., Assistant Professor, Case Western Reserve University School of Medicine and Case Comprehensive Cancer Center, 11100 Euclid Avenue, Cleveland, Ohio, 44106-5065. email: jill.barnholtz-sloan@case.edu.

Current address for Dr. Chamberlain: Department of Neurology, Division of Neuro-Oncology, University of Washington, and Seattle Cancer Care Alliance.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Adjusted Kaplan–Meier survival curves by treatment pattern type for individuals in whom GBM was diagnosed at 66–74 years of age (upper) and at ≥ 75 years of age (lower).

References

1

American Medical Association: Physician's Current Procedural Terminology: (CPT) 2001 Professional EditionChicagoAmerican Medical Association2000

2

Barnholtz-Sloan JSSloan AESchwartz AG: Relative survival rates and patterns of diagnosis analyzed by time period for individuals with primary malignant brain tumor, 1973–1997. J Neurosurg 99:4584662003

3

Batchelor TTDorfman MVHunter DJEpidemiology, pathology, and imaging of brain tumors. Black PMLoeffler JS: Cancer of the Nervous System ed 2PhiladelphiaLippincott Williams & Wilkins2005. 113

4

Brandes AFiorentino MV: Treatment of high-grade gliomas in the elderly. Oncology 55:161998

5

CBTRUS: Primary Brain Tumors in the United States: Statistical Report 1998–2002 Hinsdale, IllCentral Brain Tumor Registry of the United States2005. (http://www.cbtrus.org/reports/2005-2006/2006report.pdf) [Accessed 15 November 2007]

6

Chang SMParney IFHuang WAnderson FA JrAsher ALBernstein M: Patterns of care for adults with newly diagnosed malignant glioma. JAMA 293:5575642005

7

Chang SMParney IFMcDermott MBarker FG IISchmidt MHHuang W: Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98:117511812003

8

Cox DR: Regression models and life-tables. J Royal Stat Soc B 30:2482751972

9

Davis FGMcCarthy BJFreels SKupelian VBondy ML: The conditional probability of survival of patients with primary malignant brain tumors: surveillance, epidemiology, and end results (SEER) data. Cancer 85:4854911999

10

Deyo RACherkin DCCiol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:6136191992

11

Fernandez PMBrem S: Malignant brain tumors in the elderly. Clin Geriatr Med 13:3273381997

12

Fine HADear KBLoeffler JSBlack PMCanellos GP: Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 71:258525971993

13

Glantz MChamberlain MLiu QLitofsky NSRecht LD: Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer 97:226222662003

14

Greig NHRies LGYancik RRapoport SI: Increasing annual incidence of primary malignant brain tumors in the elderly. J Natl Cancer Inst 82:162116241990

15

Hess KRBroglio KRBondy ML: Adult glioma incidence trends in the United States, 1977–2000. Cancer 101:229322992004

16

Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958

17

Keime-Guibert FChinot OTallandier LCartalat-Carel SFrenay MKantor G: Radiotherapy for glioblastoma in the elderly. N Engl J Med 356:152715352007

18

Kelly PJHunt C: The limited value of cytoreductive surgery in elderly patients with malignant gliomas. Neurosurgery 34:62671994

19

Klabunde CNWarren JLLegler JM: Assessing comorbidity using claims data: an overview. Med Care 40:8 SupplIV26IV352002

20

Klein JMoeschberger ML: Survival Analysis: Techniques for Censored and Truncated Data New YorkSpringer1997

21

Laigle-Donadey FDelattre JY: Glioma in the elderly. Curr Opin Oncol 18:6446472006

22

Laws ERParney IFHuang WAnderson FMorris AMAsher A: Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg 99:4674732003

23

Lowry JKSnyder JJLowry PW: Brain tumors in the elderly: recent trends in a Minnesota cohort study. Arch Neurol 55:9229281998

24

Magrini SMRicardi USantoni RKrengli MLupattelli MCafaro I: Patterns of practice and survival in a retrospective analysis of 1722 adult astrocytoma patients treated between 1985 and 2001 in 12 Italian radiation oncology centers. Int J Radiat Oncol Biol Phys 65:7887992006

25

Mahaley MS JrMettlin CNatarajan NLaws ER JrPeace BB: Analysis of patterns of care of brain tumor patients in the United States: a study of the Brain Tumor Section of the AANS and the CNS and the Commission on Cancer of the ACS. Clin Neurosurg 36:3473521990

26

Mahaley MS JrMettlin CNatarajan NLaws ER JrPeace BB: National survey of patterns of care for brain-tumor patients. J Neurosurg 71:8268361989

27

Mangiola AMaira GDe Bonis PPorso MPettorini BSabatino G: Glioblastoma multiforme in the elderly: a therapeutic challenge. J Neurooncol 76:1591632006

28

Marijnen CAvan den Berg SMvan Duinen SGVoormolen JHNoordijk EM: Radiotherapy is effective in patients with glioblastoma multiforme with a limited prognosis and in patients above 70 years of age: a retrospective single institution analysis. Radiother Oncol 75:2102162005

29

Meckling SDold OForsyth PABrasher PHagen NA: Malignant supratentorial glioma in the elderly: is radiotherapy useful?. Neurology 47:9019051996

30

Mirimanoff ROGorlia TMason WVan den Bent MJKortmann RDFisher B: Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol 24:256325692006

31

Mohan DSSuh JHPhan JLKupelian PACohen BHBarnett GH: Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. Int J Radiat Oncol Biol Phys 42:9819871998

32

Patwardhan RVShorter CWillis BKReddy PSmith DCaldito GC: Survival trends in elderly patients with glioblastoma multiforme: resective surgery, radiation, and chemotherapy. Surg Neurol 62:2072152004

33

Pierga JYHoang-Xuan KFeuvret LSimon JMCornu PBaillet F: Treatment of malignant gliomas in the elderly. J Neurooncol 43:1871931999

34

Warren JLKlabunde CNSchrag DBach PBRiley GF: Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40:8 SupplIV3IV182002

35

World Health Organization: ed 6GenevaWorld Health Organization2005

36

World Health Organization: International Classification of Diseases for Oncology (ICD-O-3) ed 3GenevaWorld Health Organization2000

37

Yancik R: Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 80:127312831997

38

Yancik R: Population aging and cancer: a cross-national concern. Cancer J 11:4374412005

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 22 22 19
Full Text Views 304 304 33
PDF Downloads 40 40 16
EPUB Downloads 0 0 0

PubMed

Google Scholar