How is lung cancer treated in older adults? (2023)

lung cancerin older adults is just as treatable as in younger adults. Surgery, chemotherapy, and other ways to cure cancer or stop it from spreading are well tolerated by people in their 80s or 90s.

Unfortunately, many people are not aware of this. Research shows that patients in this age group are less likely to receive treatment. In one study, nearly two-thirds of patients aged 80 and over received no treatment after diagnosisStage 3 lung cancer.

But age alone is not a reason to forego treatment. Treatment options for early and possibly advanced lung cancer can effectively give you more and more fulfilling years of life.

Ability to tolerate treatment

Cancer treatment options are usually broken down into stages ofnon-small cell lung cancer(NSCLC) orsmall cell lung cancer(SCLC).

Early stage treatment options are consideredstage 1and someLevel 2NSCLC and some limited-stage small cell lung cancers (SCLC).

Locally advancedLung cancer treatment options are used in some stages 2 and 3 of NSCLC and extensive SCLC.

treatment foradvanced lung canceris offered to those with metastatic lung cancer that occurs at any stage 3 andLevel 4NSCLC and in extensive SCLC.

Treatment is appropriate for older adults at any of these stages. There are some who think that adults in their 80s or 90s are too "fragile" to pursue aggressive late-stage treatments, or that there is little benefit from treating lung cancer in general. Fortunately, even older adults can see positive results from therapies.

That's not to say that every lung cancer treatment option is equally appropriate or safe for people of all ages or health profiles. However, as treatments become more advanced, they are often better tolerated by adults of all ages compared to the options available in previous decades.

Options for early stage lung cancer

For people of all ages with lung cancer, diagnosis in the early stages offers opportunitychance to cure the diseaseor reduce the risk of recurrence by surgery and/or stereotactic body irradiation.

While there are concerns that surgery could be dangerous for older adults, research shows that older patients' survival rates for different types of lung cancer surgery are comparable to younger patients.

Operation

There are four main types of surgeries performed to remove lung cancer cells:

• AWedge resectioninvolves removing a wedge-shaped section of lung tissue that contains the tumor.
• A segmentectomy removes a slightly larger piece of tissue than a wedge resection.
• ALobectomyrequires the removal of an entire lobe of the lung (the right lung has three lobes and the left lung has two).
• APneumonectomyis the removal of an entire lung.

Studies of wedge resection, segmentectomy, or lobectomy to treat lung cancer have found that many older adults tolerate the surgery reasonably well, and those over 80 do not appear to be at greater risk of complications than adults 10 years and older, who are several years younger.

However, the same studies found that apneumonectomy still appears to be very risky for octogenarians, and older lung cancer patients have significantly lower survival rates after complete removal of a lung.

Of course, studies only report statistics, and a surgeon may have a much better idea of ​​what type of surgery would give you the best results based on your overall health and cancer.

It pays to look for a surgeon who specializes in lung cancer and has experience operating on older adults. Getting a second opinion is also recommended. Consider consulting with healthcare providers at one of the larger onesCancer centers designated by the National Cancer Institute. This may involve travel or some inconvenience, but you are more likely to find a doctor with expertise that suits your specific needs.

VATS: Minimally Invasive Surgery

Removal of lung tissue is usually done by one of two methods. The more traditional surgical technique is called the open procedure. An incision is made in the breast, the ribs are spread, and the cancerous tissue is removed.

A newer type of procedure is known as video-assisted thoracoscopic surgery (VATS). This is a less invasive method. The surgeon makes a few small incisions in the chest and then, using a camera and small instruments, operates without fully opening the chest.

Depending on where the tumor is located, VATS may not be an option. If this is the case, this minimally invasive approach is recommended by researchers due to the reduced risk of complications and the reduction in the time required for the surgery, which can help ensure the surgery is successful.

Specific studies in lung cancer patients over 65 show that VATS and open chest procedures have better postoperative outcomes and similar long-term survival rates compared to open chest procedures.

Stereotactic Body Irradiation (SBRT)

If your lung cancer is in the early stagesinoperable, or if you prefer not to undergo surgery, it is called targeted radiation treatmentStereotactic Body Irradiation (SBRT)may be the best option.

Research has found that SBRT for stage 1 lung cancer appears to be both safe and effective for people aged 90 and older.

Some lung cancer specialists now believe SBRT should be the treatment of choice for early-stage lung cancer in people over 80. In fact, the number of surgeries performed on such early-stage lung cancer patients has steadily decreased, while the number of patients treated with SBRT has increased significantly.

SBRT is usually well tolerated.radiation pneumonitis, an inflammation of the lungs caused by radiation, is common in older patients undergoing this procedure, but it is highly treatable.

Radiofrequenz-Ablation

Radiofrequency ablation is another alternative to surgery. This minimally invasive procedure has shown promise in eradicating tumors.

Using only a local anesthetic, healthcare providers insert thin probes through the skin to the tumor site and then send high-energy waves that heat and destroy the tumor.

In cases where there are concerns about older adults undergoing surgery, this procedure is being considered as a possible treatment.

Options for locally advanced lung cancer

In some forms of stage 2 and stage 3 NSCLC, tumors can be large and have tumorsSpread to nearby lymph nodes, or they may be small and have traveled to distant lymph nodes.

Surgery may still be an option at this point. However, because there is a higher risk of the cancer coming back, other treatments may be used in conjunction with surgery or instead of surgery.

Adjuvant Chemotherapy

Withchemotherapy, healthcare providers inject a combination of drugs intravenously. These act on cancer cells throughout the body.

Adjuvant chemotherapy refers to treatments given after surgery to kill or rid the body of cancer cells that couldn't be removed during surgeryMicrometastasis, cancer cells that may be present but are too small to be seen on imaging tests.

While there are risks of toxicity in older adults, research has shown that adjuvant chemotherapy can improve the prognosis of lung cancer patients over age 75 undergoing surgery for locally advanced NSCLC.

radiation

By delivering high-energy radiation to any remaining tumors after surgery,radiotherapyalso acts as an adjunctive therapy to support operations. This appears to be an effective treatment for all ages.

Other studies have found that chemotherapy, in which patients receive both radiation and chemotherapy, improves the prognosis for older adults. The most effective method for people aged 70 and older seems to be radiation more than 30 days after chemotherapy.

Options for advanced or metastatic lung cancer

For stage 3B and stage 4 NSCLC and extensive SCLC, surgery can be used to treat cancer in older adults. However, this is not typical. Instead, healthcare providers typically focus on systemic treatments that help relieve symptoms, prolong life, and act when necessaryPalliativpflege.

Targeted therapies

Targeted therapies are drugs that target specific signaling pathways involved in cancer growth. This can include:

• AngiogeneseInhibitors:Drugs that stop tumors from growing by targeting the blood vessels around the cancer
• Gen Mutationtherapy: Drugs that target specific genetic mutations in cancer cells that make them shrink or stop them from growing.

These drugs can be used alone or in conjunction with chemotherapy.

Targeted therapies do not cure the cancer, but they can sometimes keep the cancer at bay for longer periods and are usually very well tolerated by older patients.

There are now therapies approved by the Food and Drug Administration (FDA) for people with:

• EGFR mutations
• ALK rearrangements
• ROS1 rearrangements
• BRAF mutations
• The NTRK Refusion
• The KRAS G12C Mutation

Treatment may also be considered (either in aclinical study, off-label or extended access) for MET mutations, RET rearrangements and HER2 mutations.

Resistance to targeted therapies almost always develops over time.However, for some mutations, such as EGFR mutations, second- and third-generation drugs are now available, allowing a different drug to be used to control cancer growth.

immunotherapy

One of the many difficulties associated with aging is a phenomenon known as immunosenescence, which refers to a decline in the immune system. This affects many older adults and may be a reason for increased cancer rates in this age group.

There is growing interest among researchers to understand howimmunotherapy, which boosts the immune system so you can better fight cancer, can offset the effects of immunosenescence. For now, some immunotherapy drugs known as immune checkpoint inhibitors have been shown to improve survival outcomes in adult patients being treated for advanced NSCLC.

Four immunotherapy drugs approved by the FDA for the treatment of lung cancer, each with different indications:

• Opdivo (Nivolumab)
• Keytruda (Pembrolizumab)
• Tecentriq (atezolizumab)
• Imfinzi (Durvalumab)

These medicines do not work for all people with lung cancer, and they may take time to work. But if they are effective, they can even lead to long-term control of advanced lung cancer.

Both Opdivo and Keytruda appear to be fairly well tolerated and increase survival in older adults.

chemotherapy

When chemotherapy is used for advanced metastatic cancer, it is usually given as palliative care to reduce pain and improve quality of life. It is not intended to cure the disease.

Chemotherapy can be used alone or with an immunotherapy drug. When used alone, a combination of two chemotherapy drugs is usually recommended.

Because older adults are rarely enrolled in clinical trials of chemotherapy, there is no clear evidence of how effective these drugs are for older adults with lung cancer.

Other health problems that one might have in addition to lung cancer are a concern for chemotherapy. Certain heart conditions, more common in older adults, for example, can put a patient at risk for complications from chemotherapy.

These factors should be considered when creating a treatment plan, but they should not automatically preclude older adults from trying treatment.Instead, the individual's health and goals should be considered when evaluating treatment options.

While the side effects of chemotherapy tend to be more severe than those of targeted therapy or immunotherapy, it's important to note that the side effects people experience today are vastly different from those experienced by patients in the past. Hair loss is still common, but medications to control nausea and vomiting have progressed to the point where many people experience little or no nausea.

factors in decision-making

Chronological age alone should not determine the treatment plan for lung cancer. Still, there are age-related realities that need to be considered as you and your healthcare provider explore options.

• lack of clinical studies: Most drugs and treatments have been studied in clinical trials in younger patients, so it's not always clear how they work in adults in their 70s, 80s, or 90s.
• comorbidities: This refers to other conditions you may have in addition to lung cancer. Older patients tend to have more comorbidities than younger patients. For example, conditions that limit lung function, such asemphysema, could make lung cancer surgery less than optimal.
• Decreased kidney or liver function: Older patients are more likely to have these problems, which can make some drug treatments problematic if they are filtered through the kidneys or liver.
• Less lean body mass: A decrease in lean body mass is common in older adults. This can make you less tolerant of the weight loss that occurs with certain treatments and put you at greater riskKachexie, unintentional weight loss, loss of appetite and muscle wasting.
• Less bone marrow reserve: If this occurs in elderly patients, it can increase the risk of complicationsbone marrow suppressionfrom chemotherapy.

While these disorders can pose some challenges for some mature patients, they should not discourage anyone from seeking treatments that can be tolerated.

The complete picture

If you are in your 70s or 80s with lung cancer, remember that the age you act and feel is probably to some extent more important than your actual age when it comes to tolerating lung cancer treatment. This is in large part because it reflects your overall health and lifestyle, which feed into treatment outcomes.

Healthcare providers should consider other factors (beyond age) when deciding how an individual is tolerating treatment, such as those covered in the comprehensive geriatric assessment (CGA). This contains:

• nutritional status
• The presence of other diseases
• activity level
• Activities of Daily Living (ADLs)
• social care
• domestic environment

Healthcare professionals who don't know you as well as they do themselves may consider the age listed on your medical record to be more important when it comes to all the information they need to work with. This means you need to develop a good working relationship with your healthcare providers.

Fortunately, we live in an era of increasingly personalized cancer treatments. Taking the time to learn how to be your own advocate in your cancer care journey will help you better deal with the challenges of living with cancer and its treatments. The knowledge can even play a role in your outcome.

A word from Verywell

Lung cancer has become as treatable (and often better tolerated) in older adults as it is in younger adults. But the world hasn't necessarily caught up with these advances, and older people who have been diagnosed with lung cancer may need to speak up for themselves and ask about options. It can be helpful to seek treatment from oncologists who have experience working with older patients.