Age as a Risk Factor for Inadequate Treatment

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Abstract
To the Editor. —We don't agree with Dr Wetle1that "elders tolerate [chemotherapy] as well as or better than younger patients." In contrast to Dr Wetle's interpretation, the preliminary Eastern Cooperative Oncology Group data reported in 1983 by Begg and Carbone2actually did show increased toxic reactions in elderly patients with eight different solid cancers who had received methotrexate or lomustine. In addition, as acknowledged by the authors, there had been some selection bias against elderly patients in these studies and the median age had not been reported. These results therefore cannot be considered as being representative of the total elderly population with cancer. Other studies on the treatment of elderly patients with cancer suggest that chemotherapy-related toxic reactions occur more often than in younger patients. Armitage and Potter3retrospectively evaluated the outcome of 20 patients 70 years of age or older with diffuse histiocytic lymphoma, predominantly