Refusal of Subsequent Treatment in Patients With EGFR-mutant Non-small-cell Lung Cancer After Response to EGFR-TKIs
Saori Hashimoto1, Yoko Fujii1, Midori Ujiie1
1Division of Nursing, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan.
Background/Aim:
During the course of effective and long-term treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), some elderly patients might decline further treatment after EGFR-TKI. We conducted a study to try and understand the reasons for this treatment decision.
Patients And Methods:
We analyzed the medical records of all patients diagnosed with non-small-cell lung cancer with EGFR mutations between 2016 and 2021.
Results:
There were 108 patients who received EGFR-TKIs. Of these, 67 patients responded to TKI. These responding patients were divided into two groups according to whether they received subsequent TKI treatment. At their request, 24 patients (group A) did not receive further anticancer treatment following TKI. The other 43 patients (group B) received anticancer therapy following TKI. Progression-free survival in group A patients was significantly longer (median=18 months, range=1-67 months) than in group B patients. The reasons for not wanting subsequent treatment after TKI were older age, reduced general condition, deterioration of physical comorbid disease and dementia. Dementia was the most common reason for patients over 75 years of age.
Conclusion:
Some elderly patients with well-controlled disease might express their refusal of all subsequent anticancer therapy after TKIs. Medical staff should respond seriously to these requests.
Insights
Elderly patients with EGFR-TKI-treated lung cancer sometimes refuse further treatment. Reasons include age, poor condition, comorbidities, and dementia, with dementia being common in those over 75.
Area of Science:
- Oncology
- Geriatric Medicine
- Cancer Treatment
Background:
- Elderly patients undergoing epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy may decline further treatment.
- Understanding the reasons behind this decision is crucial for patient care.
Purpose of the Study:
- To investigate the factors influencing treatment refusal in elderly non-small-cell lung cancer (NSCLC) patients after EGFR-TKI therapy.
- To analyze the outcomes of patients who refused subsequent treatment.
Main Methods:
- Retrospective analysis of medical records of NSCLC patients with EGFR mutations (2016-2021).
- Comparison of progression-free survival between patients who received subsequent treatment and those who refused.
Main Results:
- Of 108 patients receiving EGFR-TKIs, 67 responded. 24 patients refused further treatment (Group A), while 43 received it (Group B).
- Group A had significantly longer progression-free survival (median 18 months) than Group B.
- Reasons for refusal included advanced age, poor general condition, worsening comorbidities, and dementia, with dementia being prevalent in patients >75 years.
Conclusions:
- Elderly patients with well-controlled cancer may refuse further therapy after EGFR-TKI treatment.
- Medical professionals must seriously consider and address patient requests to forgo subsequent treatments.
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