Older Patients w/ LC benefit from Comprehensive Treatments

[Hebbie]

Older patients with lung cancer benefit from comprehensive anticancer treatments

Reuters Health

Posting Date: December 25, 2003

Last Updated: 2003-12-25 8:00:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Despite their increased risk of complications, older patients with lung cancer can benefit from surgery, radiation, and chemotherapy where indicated, according to a report in the November/December issue of CA Cancer Journal for Clinicians.

Two-thirds of the lung cancer patients in the United States are 65 years or older, the authors explain, but knowledge about their optimal treatment is limited because of the underrepresentation of older patients in clinical trials.

Dr. Arti Hurria and Dr. Mark G. Kris from Memorial Sloan-Kettering Cancer Center, New York reviewed the available data regarding surgery, radiation, and systemic therapy for older patients with lung cancer and considered the role of geriatric assessment in their evaluation.

The authors recommend the use of a comprehensive geriatric assessment, including evaluation of functional status, comorbid medical conditions, nutritional status, cognition, psychological function, social support, and medication review.

Clinical trials support surgery as the mainstay of treatment for early-stage non-small cell lung cancer (NSCLC) even in older patients, the authors report, and radiation therapy can be given with curative or palliative intent to older patients with lung cancer.

Although there is no curative chemotherapy for advanced NSCLC, the review indicates, response rates do not appear to differ significantly between older and younger patients. Older patients do, however, face a higher risk of complications.

In small cell lung cancer (SCLC), undertreatment of older patients is common, the reviewers note, but dose reductions have not resulted in lower response or survival rates.

Similarly, the results indicate, older SCLC patients treated with chemotherapy and thoracic irradiation fared no worse than did younger SCLC patients in terms of response or survival rates.

"Because the population is aging and lung cancer affects a significant number of older persons," the authors conclude, "we need to focus additional resources on efforts to maximize treatment efficacy, minimize toxicity, and understand treatment preferences of this patient population."

"Although age is associated with increased risk for surgical and radiation complications, these forms of treatment seem overall to be advantageous to older persons, and age should not impede their use in patients without other contraindications," agrees Dr. Lodovico Balducci from H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida in a related editorial.

"[This review] demonstrates that chronologic age is not a contraindication to effective treatment of older patients with lung cancer, regardless of whether surgery, radiation therapy, cytotoxic chemotherapy, or a combination of these treatments is necessary," he adds.

CA Cancer J Clin 2003;53:325-341, 322-324