Background: The number of elderly stage IV cancer patients is increasing every year. Various factors need to be considered for systemic cancer treatment in older patients. This study was conducted to examine the difference in clinical features and overall survival between the group that received the best supportive care and the group that received active systemic chemotherapy in solid cancer patients over 80 years of age.
Methods: This study was conducted in patients over 80 years of age who were diagnosed with stage 4 solid cancer at Yonsei Cancer Center from October 20, 2018, to October 20, 2023. Breast cancer, prostate cancer, and lung cancer were excluded. A descriptive analysis was conducted to assess patient characteristics. The Kaplan-Meier method was used to analyze the patients’ overall survival and treatment outcomes.
Results: There was a total of 179 patients, with 80 in the best supportive care (BSC) group and 99 receiving systemic chemotherapy. The patient in the treatment group was younger than in the BSC group (85±4.26 vs.82±2.51, p = 0). There was no difference in mortality in the two groups (83.8% vs. 72.7%, P = 0.078). Compared to the BSC group, the treatment group showed a long overall survival (2.5 months vs. 9.9 months, p < 0.001). Patients with ECOG 0-2 in the treatment group had a median overall survival of 10.2 months, superior to 7.3 months for patients with ECOG 3-4, which showed differences according to ECOG status (p = 0.009). However, when comparing the overall survival of patients aged 80-84 and those over 85 in the treatment group, there was no significant difference between the two groups. (9.7 months vs. 7.3 months, p = 0.267). In the BSC group and the treatment group, the rates of Advance Directives (AD) completion were 10% and 12.5%, respectively. The completion rates for POLST (Physician Orders for Life-Sustaining Treatment) were 53% and 50% overall, with no significant difference between the two groups (p = 0.507). However, it was noted that despite the advanced age of both groups, the rates of AD completion were low.
Conclusions: In patients over 80 years of age with stage IV cancer, if the patient’s performance status is good, receiving systemic chemotherapy is beneficial. In elderly cancer patients, Comprehensive geriatric assessment (CGA) of the elderly, including overall psycho-nervous system evaluation, function evaluation, and social evaluation, is essential during the cancer diagnosis process. Furthermore, in elderly patients, preparing Advance Directives (AD) in advance at the time of cancer diagnosis is necessary for the patient’s end-of-life care.