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Management of elderly patients with lung cancer

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Abstract

Cancer management in the older patient is a growing concern, particularly with the increasing geriatric population and the high incidence of cancer among these individuals. Incidence of lung cancer in particular is known to rise with age. This article reviews prognosis, treatment options, and decision-making issues for both clinician and patient with respect to both non-small-cell and small-cell lung cancer in this population. Research findings dealing with response rates, survival rates, and symptom control in this age group are reviewed for radiotherapy, surgery, and for various chemotherapy agents, including gemcitabine, the taxanes, vinorelbine, and the topoisomerase 1 inhibitors. Quality of-life issues are also addressed.

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References and Recommended Reading

  1. Brown JS, Eraut D, Trask C, Davidson AG: Age and treatment of lung cancer. Thorax 1996, 51:564–568.

    PubMed  CAS  Google Scholar 

  2. Exterman M, Overcash J, Lyman Gh, et al.: Co-morbidity and functional status are independent in older cancer patients J Clin Oncol 1998, 16:1582–1587.

    Google Scholar 

  3. Silvestri G, Pritchard R, Welch GH: Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. Br Med J 1998, 317:771–775. A provocative paper that challenges some of the assumptions about patient preferences for palliative treatment, although the patient cohort may not be representative of an untreated patient population.

    CAS  Google Scholar 

  4. Brundage MD, Davidson JR, Mackillop WJ: Trading treatment toxicity for survival in locally advanced non-small cell lung cancer. J Clin Oncol 1997, 15:330–340.

    PubMed  CAS  Google Scholar 

  5. Slevin ML, Stubbs L, Plant HJ, et al.: Attitudes to chemotherapy: comparing views of patients with those of doctors nurses and the general public. Br Med J 1990, 300:1458–1460.

    Article  CAS  Google Scholar 

  6. Soquet PJ, Chavin F, Boissel J, et al.: Polychemotherapy in advanced non-small cell lung cancer: a meta-analysis. Lancet 1993, 342:19–21.

    Article  Google Scholar 

  7. Non-small Cell Lung Cancer Cooperative Group: Chemotherapy in NSCLC using updated data on individual patients from 52 randomised clinical trials. Br Med J 1995, 311:899–909.

    Google Scholar 

  8. Thomas P, Piraux M, Jacques LF, et al.: Clinical patterns and trends of outcome of elderly patients with bronchogenic carcinoma. Eur J Cardiothorac Surg 1998, 13:266–274.

    Article  PubMed  CAS  Google Scholar 

  9. Teeter SM, Holmes FF, McFarlane MJ: Lung carcinoma in the elderly population. Influence of histology on the inverse relationship of stage to age. Cancer 1987, 60:1331–1336.

    Article  PubMed  CAS  Google Scholar 

  10. Shepherd FA, Abratt PR, Anderson H, et al.: Gemcitabine in the treatment of elderly patients with advanced NSCLC. Semin Oncol 1997, 24(suppl 2):50–55. A review of phase II data on gemcitabine that specifically addresses the merits of the drug in an elderly population and identifies the fact that some subgroups of elderly patients fare surprisingly well.

    CAS  Google Scholar 

  11. O’Rourke MA, Feussner JR, Feigl P, et al.: Age trends of lung cancer stage at diagnosis: implications for lung cancer screening in the elderly. JAMA 1987, 258:921–926.

    Article  PubMed  CAS  Google Scholar 

  12. Zagonel V, Pinto A, Serraino D, et al.: Lung cancer in the elderly. Cancer Treat Rev 1994, 20:315–329.

    Article  PubMed  CAS  Google Scholar 

  13. Smith TJ, Penberthy L, Desch CE, et al.: Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer 1995, 13:235–252.

    Article  PubMed  CAS  Google Scholar 

  14. Jack CI, Lye M, Lesley F, et al.: Surgery for lung cancer: age alone is not a contraindication. Int J Clin Pract 1997, 51:423–426.

    PubMed  CAS  Google Scholar 

  15. Damhuis RA, Schutte PR: Resection rates and post-operative mortality in 7899 patients with lung cancer. Eur Respir J 1996, 9:7–10.

    Article  PubMed  CAS  Google Scholar 

  16. Ciriaco P, Zannini P, Caretta A, et al.: Surgical treatment of NSCLC in patients 70 years of age or older. Int Surg 1998, 83:4–7.

    PubMed  CAS  Google Scholar 

  17. Foucher P, Coudert B, Arveux P, et al.: Age and prognosis of NSCLC: usefulness of a relative survival model. Eur J Cancer 1993, 29A:1809–1813.

    Article  PubMed  CAS  Google Scholar 

  18. Hickish TF, Smith IE, O’Brien MER, et al.: Clinical benefit from palliative chemotherapy in NSCLC extends to the elderly and those with poor prognostic features. Br J Cancer 1998, 78:28–33. A retrospective analysis of the pretreatment characteristics determining survival, objective response, and symptom relief in patients treated for advanced NSCLC at a single institution. The authors note that symptom relief is still commonly seen even in patients with the worst outlook and that age is not an adverse factor in palliation.

    PubMed  CAS  Google Scholar 

  19. Thongprasert S, Sanuanmitra P, Juthapan W: Final report on quality of life and clinical outcomes in advanced non-small cell lung cancer [abstract]. Proc ASCO 1996, 15:407.

    Google Scholar 

  20. Cullen MH, Woodroffe CM, Billingham LJ, et al.: Mitomycin, ifosfamide and cisplatin (MIC) in non-small cell lung cancer (NSCLC): results of a randomised trial in patients with extensive disease [abstract]. J Int Assoc Study Lung Cancer 1997, 18(suppl 1):11.

    Google Scholar 

  21. Helsing M, Berman N: Chemotherapy with carboplatin and etoposide improves quality of life and survival in patients with advanced NSCLC. J Int Ass Study Lung Cancer (1997) 18(suppl 1):Abst 8.

  22. Anelli A, Lima CA, Younes JL, et al.: Relationship between treatment modality and clinical outcomes in NSCLC [abstract]. Proc ASCO 1997, 16:58.

    Google Scholar 

  23. Anderson H, Cottier B, Nicholson M, et al.: Phase III study of gemcitabine versus best supportive care in advanced nonsmall cell lung cancer [abstract]. J Int Assoc Study Lung Cancer 1997, 18(suppl 1):24.

    Google Scholar 

  24. Thatcher N, Ranson M, Anderson H, et al.: Phase III study of paclitaxel versus best supportive care in inoperable NSCLC. Ann Oncol 1998, 9(suppl 4):1.

    Google Scholar 

  25. The Elderly Lung Cancer Vinorelbine Italian Study Group: Effects of vinorelbine on quality of life and survival of elderly patients with advanced NSCLC. J Natl Cancer Inst 1999, 91:66–72. Report presenting important new data on vinorelbine as a single agent indicating that it increases survival in elderly patients with advanced NSCLC compared with supportive care alone. Quality of life was broadly comparable for the two approaches.

    Article  Google Scholar 

  26. Anderson H, Thatcher N, Walling J, et al.: Gemcitabine and palliation of symptoms in non-small cell lung cancer [abstract]. Proc ASCO 1994, 13:367.

    Google Scholar 

  27. Perng RP, Chen YM, Ming-Liu J, et al.: Gemcitabine versus the combination of cisplatin and etoposide in patients with inoperable NSCLC in a phase II randomised study. J Clin Oncol 1997, 15:2097–2102.

    PubMed  CAS  Google Scholar 

  28. Manegold CH, Stahel R, Mattson K, et al.: Randomized phase II study of gemcitabine monotherapy versus cisplatin plus etoposide in patients with locally advanced or metastatic NSCLC [abstract]. Proc ASCO 1997, 16:1651.

    Google Scholar 

  29. Ranson M, Thatcher N: Paclitaxel: a hope for advanced NSCLC? Exp Opin Invest Drugs 1999, 8:837–848.

    Article  CAS  Google Scholar 

  30. Bonomi P, Kim K, Kusler J, et al.: Cisplatin/etoposide vs paclitaxel/cisplatin/GCSF vs paclitaxel/cisplatin in NSCLC. Oncology 1997, 11(suppl 3):9–10.

    PubMed  CAS  Google Scholar 

  31. Giaccone G, Splinter TA, Debruyne C, et al.: Randomised study of paclitaxel-cisplatin versus cisplatin-teniposide in patients with advanced NSCLC: the EORTC and Treatment of Lung Cancer Cooperative group. J Clin Oncol 1998, 16:2133–2141.

    PubMed  CAS  Google Scholar 

  32. Bunn PA, Kelly K: New chemotherapeutic agents prolong survival and improve quality of life in NSCLC: a review of the literature and future directions. Clin Cancer Res. (1998) 5:1087–1100.

    Google Scholar 

  33. Gil Deza E, Balbiani L, Coppola F, et al.: Phase III study of navelbine vs navelbine plus cisplatin in NSCLC stage IIIB or IV [abstract]. Proc ASCO 1996, 15:394.

    Google Scholar 

  34. Le Chevalier T, Brisgand D, Douillard JY, et al.: Randomized study of vinorelbine and cisplatin versus vindesine and cisplatin versus vinorelbine alone in advanced NSCLC: results of a European multicentre trial including 612 patients. J Clin Oncol 1994, 12:360–366.

    Google Scholar 

  35. JohnsonDH: Small cell lung cancer in the elderly patient. Semin Oncol 1997, 24:484–491.

    PubMed  CAS  Google Scholar 

  36. Albain KS, Crowley JJ, LeBlanc M, et al.: Determinants of the improved outcome in small-cell lung cancer: an analysis of the 2580-patient Southwest Oncology Group database. J Clin Oncol 1990, 8:1563–1574.

    PubMed  CAS  Google Scholar 

  37. Radford JA, Ryder WD, Dodwell D, et al.: Predicting septic complications of chemotherapy: an analysis of 382 patients treated for small cell lung cancer without dose reduction after major sepsis. Eur J Cancer 1992, 29A:81–86.

    PubMed  CAS  Google Scholar 

  38. Lassen UN, Osterlind K, Hirsch FR, et al.: Early death during chemotherapy in patients with small cell lung cancer: derivation of a prognostic index for toxic death and progression. Br J Cancer 1999, 79:515–519.

    Article  PubMed  CAS  Google Scholar 

  39. Murray N, Grafton C, Shah A, et al.: Abbreviated treatment for elderly, infirm or non-compliant patients with limited stage small cell lung cancer. J Clin Oncol 1998, 16:3323–3328. Abbreviated treatment of limited-stage small-cell lung cancer in elderly and infirm patients can produce promising long-term survival rates, according to these authors. This report should serve as a stimulus to further studies to optimize treatment in this population.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Oncology, Christie Hospital NHS Trust and Holt Radium Institute, Wilmslow Road, M20 4BX, Manchester, UK

    Malcolm R. Ranson PhD, FRCP, Shane White MB, ChB & Nicholas Thatcher PhD, FRCP

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  1. Malcolm R. Ranson PhD, FRCP
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  2. Shane White MB, ChB
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  3. Nicholas Thatcher PhD, FRCP
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Ranson, M.R., White, S. & Thatcher, N. Management of elderly patients with lung cancer. Curr Oncol Rep 2, 90–95 (2000). https://doi.org/10.1007/s11912-000-0015-y

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