Adoption of adjuvant chemotherapy (ACT) for non-small cell lung cancer (NSCLC) in the elderly: A population-based outcomes study.
Bibliographic record
Abstract
7012 Background: Subgroup analyses of JBR.10 and the LACE meta-analysis suggest that the elderly benefit from ACT with acceptable toxicity. Here we evaluate uptake of ACT and its impact on outcome by age group in the general population of Ontario. Methods: All NSCLC cases surgically resected in Ontario 2001-2006 were identified from the population-based Ontario Cancer Registry. Electronic treatment records were linked to the registry. Uptake of ACT was compared across age groups: <70, 70-74, 75-79, 80+ years. As a proxy of benefit from ACT, we compared survival of cases diagnosed in 2004-2006 to 2001-2003 (ACT trials reported in 2004). Hospitalization rates within 6 months of surgery served as a proxy of treatment related toxicity. Results: 2763/6304 (44%) eligible cases were elderly (≥70 yrs). The elderly were more often male, had more co-morbidities and longer postoperative stays. They were less likely to have adenocarcinoma, undergo pneumonectomy or be treated at a regional cancer center. Uptake of ACT in the elderly increased from 3.3% in 2001-2003 to 16.2% in 2004-2006 (p<0.001). Adoption of ACT declined with age: 43% in <70yrs, 23% in 70-74yrs, 13% in 75-79yrs and 5% in 80+yrs (p<0.001). Among evaluable elderly cases 70% received cisplatin, 28% carboplatin (versus 85% and 14% of cases <70yrs [p=0.005]). Dose modifications and drug substitutions were similar across age groups. In the elderly, 4-yr survival increased from 47.1% in 2001-2003 to 49.9% in 2004-2006 (p=0.01). Hospitalization rates within 6-24 weeks of surgery were similar across the age groups (p=0.54). Age, pathological stage, and geographical region were independently associated with receipt of ACT in the elderly. Conclusions: Adoption of ACT in the elderly was associated with significant improvement in overall survival without apparent increase in severe toxicity as judged by hospital admission. Our findings confirm that the benefits of ACT in the elderly, suggested by the relevant clinical trials, are being realized in the general population. Efforts to understand and improve underutilization of ACT in the elderly in clinical practice are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".