Lung Cancer in Older or Sick Adults

Reviewed by: HU Medical Review Board | Last reviewed: January 2020.

Lung cancer affects older people the most. It is often diagnosed in people ages 65 to 74. Between 2009-2015, 70 percent people with lung cancer were 65 and older.1-2

Taking age into account in treatment decisions

Most people are diagnosed with lung cancer at Stage III or Stage IV disease. The stage of the cancer at diagnosis is a better predictor of long-term survival than the person’s age.

However, treatment may need to be adjusted for older patients, depending on their overall health. Some studies suggest that having other conditions in addition to lung cancer lowers the chances of long-term survival, regardless of age.3,4

Treatment for lung cancer is based on the stage of the disease. Stages are used to describe how advanced a cancer is. In older or sick patients, other health conditions must be taken into account when choosing a treatment approach.

Impact of additional health conditions

One study looked at the medical history of older people to understand how age and other health conditions impacted the choice of treatment and survival. The patients had non-small cell lung cancer (NSCLC) and averaged 63 years old. More than half had other diseases. The most common health issues were chronic obstructive pulmonary disease (COPD) and cardiovascular disease.

The researchers found that the presence of other health conditions affected treatment recommendations. Having at least 2 other health conditions negatively impacted survival in advanced stages of lung cancer, regardless of the person’s age.

Different treatment recommendations for older adults

The study also found that age should not factor into whether chemotherapy is used because the treatment improved survival in both younger and older people. However, other health conditions may decide whether chemotherapy is a good option for some older people.4

Regular radiation usually is not recommended for older people because it requires daily treatment over 6-7 weeks. Frailty of the person, and a high likelihood of the cancer coming back after radiation, also discourage its use in the elderly. Lung cancer surgery is often not recommended for those over 75. However, a study from the Netherlands found that the survival of older patients with stage I NSCLC increased greatly with stereotactic ablative radiotherapy.5,6

With SABR, high doses of radiation are targeted at the tumor from different angles. This takes place during 3 to 5 visits. This method limits radiation to healthy parts of the body. The study found SABR improved survival rates by nearly 10 months in older people.5,6

Possible lower treatment tolerance

An Italian study looked at the use of chemotherapy and targeted therapies in elderly people with several health conditions. It found older people did not tolerate toxic medical treatments as younger people. The study found that elderly patients tend to tolerate targeted treatment well, especially EGFR inhibitors.7

However, elderly people are also at risk for undertreatment which contributes to poor survival rates.

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