The government may soon draft new guidelines for cancer treatment in light of a recent study that suggests cancer drugs may be ineffective in elderly patients.
Tokyo-based National Cancer Center Japan (NCC) on Thursday released the findings of research showing a correlation between the efficacy of cancer drugs and patients’ ages.
Masaharu Tanto, senior coordinator of the Health, Labor and Welfare Ministry, said that although the draft will have the new findings in mind, it won’t be solely based on the results of the NCC study.
The preliminary findings of the study show that the prognosis for lung cancer patients 70 and older worsened even in stage 1, when tumors are relatively small and haven’t metastasized.
The study covered 6,900 patients with lung, bowel, stomach, breast and liver cancer who received treatment at the National Cancer Center Hospital in 2007 and 2008. Of the total, 21 percent were 70 or older.
Patients over 75 who were being treated with drugs did not show significant improvement compared with similarly aged patients who weren’t on medication. This was true for patients in stage 2 through stage 4, when tumors have spread to surrounding tissue or other organs.
The researchers observed a significant decline in the survival rate for patients with first-stage stomach cancer 80 and older regardless of whether cancer drugs had been taken. However, the efficacy of treatments for patients in advanced stages could not be determined since there were too few patients in the study, researchers said. Other data suggests that patients in stage 4 and above lived longer if they were treated with drugs.
The main focus of the research centered on the 1,250 patients with advanced cancer and how they responded to cancer drugs.
For patients with bowel cancer, the results of the medication were similarly inconclusive, said the NCC. These drugs were less effective in the early stage and proved ineffective in several advanced cases where the cancer had spread.
The researchers compared the survival statistics of elderly and non-elderly patients, and separated the results of treatment that was based on carcinostatic drugs from treatment that was centered around palliative care.
The group cautioned against using age as the main deciding factor for determining treatment — especially in cases of advanced breast cancer — since there may be other important considerations.
Regarding the government’s use of this research, Tanto said that although the information will be used for reference in further research, the results will not be the guideline’s decisive factor.
He also denied the guidelines would be used as means to reduce cost of cancer treatment, saying the decisions should be entrusted to doctors.
An NCC official who requested his name be withheld said Thursday by telephone that although the study helped observe that cancer drugs may not be sufficiently effective in elderly patients, further research efforts are needed.
“I think more thorough research on a larger scale on cancer treatment in Japan is needed,” he said.
“Given that many of elderly cancer patients suffer also from other diseases, it is hard to conduct such as study,” and the number of patients analyzed was not enough to make unqualified conclusions, the official said.
“We should take into account not only patients’ age but their situation as many elderly patients suffering from other diseases find it hard to concentrate on cancer treatment and related expenses,” he added.
He added that globally, Japan has among the highest levels of access to cancer treatments covered under national health insurance.
Speaking in an unofficial capacity, Yuichiro Ohe, president of the Japanese Society of Medical Oncology, said: “There is a possibility that life-extending efficacy of cancer drugs in elderly people is lower than in a younger group.” He added that reduced functional fitness in elderly people may be a contributing cause.
Ohe said he believes that the government’s guidelines should be evidence-based to guarantee optimal treatment.
The study was conducted at the request of the Japan Agency for Medical Research and Development, the nation’s leading research medical institution, which is backed by the government.
“This study was aimed at comparing the effectiveness of various kinds of treatment such as radiation therapy, not only chemotherapy,” said AMED’S Yoichiro Miyokawa in charge of research on medical equipment. “I believe it will be the health ministry’s decision how to use this information.”
The move comes after a government panel decided last November to cut the official price of the cancer drug Opdivo by 50 percent, amid fears that widespread use of the newly approved and expensive drug could drain state coffers.
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