ABSTRACT
Most patients with non-small-cell lung cancer (NSCLC) are elderly but evidence to guide appropriate treatment decisions for this age group is generally scant. Careful evaluation of the elderly should be undertaken to ensure that treatment appropriate for the stage of the tumour is guided by patient characteristics and not by age. The Comprehensive Geriatric Assessment (CGA) remains the preferred option, but briefer tools may be appropriate to select patients for further evaluation. The predicted outcome should be used to guide management decisions together with a reappraisal of polypharmacy. Patient expectations should also be taken into account. Management recommendations are generally similar to those of general guidelines for the NSCLC population, although the risks of surgery and toxicity of chemotherapy and radiotherapy are often increased in the elderly compared with younger patients; therefore, patients should be closely scrutinised and subjected to a CGA to ensure suitability of the planned treatment. If surgery is indicated, then lobectomy is generally the preferred option, although limited resection may be more feasible for some. Radiotherapy with curative intent is an alternative, with stereotactic body radiotherapy the most likely preferred modality. Adjuvant chemotherapy is also an appropriate approach, whereas adjuvant radiotherapy is generally not recommended. Concurrent chemoradiotherapy should be considered for elderly patients with inoperable locally advanced disease and chemotherapy for advanced/metastatic disease. Efforts should also be made to increase participation of elderly patients with NSCLC in clinical trials, thereby enhancing evidence-based treatment decisions for this majority group. This will require overcoming barriers relating to trial design and to physician and patient awareness and attitudes.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/therapy , Disease Management , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Aged , Aged, 80 and over , Chemotherapy, Adjuvant/methods , Clinical Trials as Topic/methods , Combined Modality Therapy/methods , Geriatric Assessment/methods , Humans , Radiotherapy, Adjuvant/methodsABSTRACT
OBJECTIVE: To compare patient preference for sildenafil citrate (sildenafil) vs. tadalafil and for their respective dosing instructions in a cohort of Spanish patients with erectile dysfunction (ED). MATERIAL AND METHODS: Sixty four Spanish patients from a multicenter, two period, cross-over, double-blind study (265 patients enrolled in total) were randomized to receive on-demand sildenafil 50 mg or tadalafil 20 mg for 12 weeks and afterwards were crossed over to the alternate regimen for another 12 weeks to assess drug preference in an extension period of the study. Similarly, to evaluate preference for their respective dosing instructions, 30 patients were randomized to one of the 2 arms treated with tadalafil: one with sildenafil (S) dosing instructions and the other with tadalafil (T) dosing instructions. RESULTS: Seventy percent of 56 patients completing the study chose to receive tadalafil treatment versus sildenafil treatment (30%) in the extension period (p<0.01). Correspondingly, 73% of 13 evaluating each drug dosing instructions preferred T dosing instructions (p>0.05). Preference did not vary with age, concomitant diseases and previous use of sildenafil. CONCLUSIONS: In this study, 7 out of 10 patients preferred tadalafil and its dosing instructions to sildenafil, for the treatment of their ED.
Subject(s)
Carbolines/therapeutic use , Erectile Dysfunction/drug therapy , Patient Satisfaction , Phosphodiesterase Inhibitors/therapeutic use , Piperazines/therapeutic use , Adult , Aged , Double-Blind Method , Europe , Humans , Male , Middle Aged , Purines , Sildenafil Citrate , Sulfones , Tadalafil , United StatesABSTRACT
Fundamento y objetivo: Comparar la preferencia por sildenafilo vs. tadalafilo, y por sus instrucciones de administración en una cohorte de pacientes españoles con disfunción eréctil (DE). Material y método: 64 pacientes españoles participantes en un estudio multicéntrico, de 2 periodos, cruzado y doble-ciego (con 265 pacientes en total) se distribuyeron aleatoriamente para recibir sildenafilo (50 mg) o tadalafilo (20 mg) a demanda durante 12 semanas, tras lo cual se cruzaron para recibir el régimen alternativo otras 12 semanas, para valorar la preferencia por uno de los dos tratamientos en una fase de extensión del estudio. Igualmente, para valorar la preferencia por las respectivas instrucciones de administración, 13 pacientes se distribuyeron en 2 brazos de tratamiento con tadalafilo 20 mg: uno con las instrucciones de administración de sildenafilo (S) y otro con las de tadalafilo (T). Resultados: De los 56 pacientes que finalizaron el estudio, un 70% eligieron recibir tratamiento con tadalafilo frente a sildenafilo (30%) en la extensión (p0,05). La preferencia no varió con la edad, enfermedades concomitantes o uso previo de sildenafilo. Conclusiones: En este estudio, aproximadamente 7 de cada 10 pacientes prefirieron tadalafilo y sus instrucciones de administración frente a sildenafilo, como tratamiento para su DE
Objective: To compare patient preference for sildenafil citrate (sildenafil) vs. tadalafil and for their respective dosing instructions in a cohort of Spanish patients with erectile dysfunction (ED). Material and methods: Sixty four Spanish patients from a multicenter, two period, cross-over, double-blind study (265 patients enrolled in total) were randomized to receive on-demand sildenafil 50 mg or tadalafil 20 mg for 12 weeks and afterwards were crossed over to the alternate regimen for another 12 weeks to assess drug preference in an extension period of the study. Similarly, to evaluate preference for their respective dosing instructions, 30 patients were randomized to one of the 2 arms treated with tadalafil: one with sildenafil (S) dosing instructions and the other with tadalafil (T) dosing instructions. Results: Seventy percent of 56 patients completing the study chose to receive tadalafil treatment versus sildenafil treatment (30%) in the extension period (p0.05). Preference did not vary with age, concomitant diseases and previous use of sildenafil. Conclusions: In this study, 7 out of 10 patients preferred tadalafil and its dosing instructions to sildenafil, for the treatment of their ED
