Are Patients Older Than 90 Candidates for Lung Cancer Treatment?
Posted: Tuesday, January 28, 2020
Patients older than 90 with non–small cell lung cancer (NSCLC) often do not receive therapy based on their age, although treatment is associated with a significant survival benefit in these patients. Chi-Fu Jeffery Yang, MD, of Stanford University in California, and colleagues published data in The Annals of Thoracic Surgery suggesting that treatment should not be withheld based on age alone but should be considered based on disease stage and patient preferences.
“We are particularly concerned that healthy, otherwise fit patients are not being recommended any type of treatment simply because they are 90 years and older,” said Dr. Yang in a press release from The Society of Thoracic Surgeons. “[O]ur study suggests that elderly patients with lung cancer who receive curative-intent, standard-of-care treatment in a multidisciplinary setting can have better outcomes than what you might have initially expected.”
Researchers focused on data from the National Cancer Database from 2004 to 2014 for patients older than 90 who were diagnosed with any stage of NSCLC. Of the 7,205 patients identified, 57.6% did not receive any therapy. For patients who did receive some sort of medical or surgical treatment, their 5-year survival was significantly better than that of patients who did not receive therapy—9.3% and 1.7%, respectively.
Patients with stage I disease saw the largest survival benefit with treatment, as those who were treated had a median survival of 27.4 months compared with 10.0 months with no treatment. Just 12.7% of the patients with stage I disease underwent surgery, and 33% had no therapy at all. Surgery was associated with a 5-year survival of 33.7%, and nonoperative therapy yielded a 5-year survival of 17.1%; no treatment was linked with a 5-year survival of 6.2%.
“It is unclear why patients are not receiving therapy, but we speculate that ageism may be a factor,” commented Dr. Yang.
Disclosure: For full disclosures of the study authors, visit annalsthoracicsurgery.org.