Abstract
The median age of presentation with lung cancer is 71, making the elderly the dominant
subgroup. Although some elderly patients are frail, others have great physiological
reserve. Geriatric assessment can clarify the specific strengths and weaknesses of
older patients, improving management. This assessment should, at the minimum, encompass
performance status, comorbidity, medications, level of independence in activities
of daily living and instrumental activities of daily living, cognitive assessment,
nutrition assessment, and assessment of social support. The fit elderly with localized
disease should be offered curative resection; video-assisted thoracic surgery may
be preferred over thoracotomy. Fit septuagenarians with node positive or > 4 cm primary
tumors should then be considered for adjuvant chemotherapy. For less fit patients,
the data on stereotactic radiosurgery indicate that it presents a viable treatment
option. Data on stage III disease are limited but suggest that chemoradiotherapy,
particularly when the chemotherapy is administered on a weekly schedule, is feasible
in fit older patients. For the older patients with metastatic cancer, abundant tissue
should be obtained at diagnosis to allow for comprehensive molecular characterization
with the hopes of rendering the patient eligible for targeted therapy. When such a
targeted therapy is not available, there is duration of life and quality of life benefit
to the administration of cytotoxic chemotherapy. The standard of care for older patients
with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2 is a platinum-based
doublet. Prospective data on second-line therapy after failure of first-line therapy
are limited but suggest a benefit to treatment.
Keywords
elderly - geriatric - geriatric assessment
