Lung Cancer in the Elderly: Factors to Consider

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Introduction

The issue of cancer in the elderly is of growing concern given the aging population. It is a particular issue in lung cancer, where the median age of patients is over 60. Aging is associated with changes in respiratory, cardiovascular, and hepatic physiology that are of particular importance to patients with thoracic disease in general and lung cancer in particular. In addition, the close association between tobacco abuse and lung cancer (90% of patients with lung cancer are current or ex-smokers) raises unique issues. As a result of tobacco abuse, the majority of lung cancer patients will be at elevated risk for cardiovascular and pulmonary diseases compared with other individuals of similar age. The issue of lung cancer treatment in the elderly has been the subject of recent comprehensive reviews.¹

Elderly patients with lung cancer should neither be undertreated nor overtreated. In the past, arbitrary numerical definitions of age have resulted in undertreatment. This is particularly relevant in the area of curative therapy, where undertreatment can result in an elevated risk of recurrence. Those caring for patients with lung cancer should not lose sight of the fact that this is an extraordinarily symptomatic disease, and morbidity due to the local and systemic effects of the disease can be considerable. Conversely, overtreatment can also be a risk. Geriatric patients with lung cancer are clearly at greater risk for toxicity due to chemotherapy and other interventions, particularly if they are frail or have serious comorbidity. Judicious, individualized care based on the results of clinical research is critical for these patients.