Lung Cancer in Older or Sick Adults

Lung cancer mostly affects the elderly. It is most commonly diagnosed among people 65-74 years of age. In 2011, 82% of lung cancer patients were 60 years of age or older.1-2 Most patients that are diagnosed with lung cancer are diagnosed with Stage III or Stage IV disease. Age is not a significant factor for predicting overall survival of lung cancer; the staging of the disease is more relevant to survival rates. For most patients, age does not affect how a person respond’s to treatment. However, treatment options may need to be adjusted for older patients, depending on their overall health. Some studies suggest that having other health conditions, or comorbidities, has a negative impact on a patient’s prognosis, regardless of the age of a patient. This means that having other health conditions may have more of an impact on survival than age.3,4

Treatment for Lung Cancer in the Elderly and the Sick

Treatment for lung cancer is based on the stage (or extent) of the disease. In elderly or sick patients, comorbidities are also taken into account when deciding on a treatment approach.

One study looked at the medical history of elderly patients 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 were an average age of 62.7 years. Approximately 57% of the patients had other diseases, most commonly chronic obstructive pulmonary disease (COPD) and cardiovascular disease. The researchers found that the presence of other health conditions affected treatment recommendations, and having at least two other health conditions negatively affected survival in advanced stages of lung cancer, independent of the patient’s age. This means the other health conditions had more of an impact on survival than age. The study also found that the age of the patient should not factor in to whether chemotherapy is an appropriate option because the treatment improved survival in both younger and older patients. However, the study did conclude that comorbidities may influence whether chemotherapy is an appropriate treatment in individual patients.4

Another study conducted in the Netherlands, presented at the 14th World Congress on Lung Cancer in 2011, found that the survival of elderly patients with stage I NSCLC increased significantly with stereotactic ablative radiotherapy, also known as stereotactic body radiotherapy (SABR). Conventional radiation therapy is not usually considered a beneficial option for elderly patients due to its daily treatment over 6-7 weeks, the potential frailty of the patients, and the high recurrence rates (cancer coming back). With SABR, high doses of radiation are targeted at the tumor from different angles over 3-5 visits, while minimizing exposure to healthy parts of the body. The study demonstrated elderly patients treated with SABR had an increase in survival rates by nearly 10 months.5,6

An Italian review article which evaluated the use of chemotherapy and targeted therapies (those which target specific genetic mutations found in certain lung cancer tumors) also found that the higher number of comorbidities elderly patients have makes them less able to tolerate toxic medical treatments, as compared to younger patients. However, elderly patients are also at risk for undertreatment (receiving less aggressive cancer treatment), which results in poor survival rates. The review noted that elderly patients do tolerate targeted treatment well, particularly EGFR inhibitors  Tarceva (erlotinib) and Iressa (gefitinib).7

Written by: Emily Downward | Last reviewed: January 2017.
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