Non-small cell lung cancer in octogenarians: treatment practices and preferences

Among patients with non-small cell lung cancer (NSCLC), patients aged 80 or older have inferior survival. Treatment practices in this patient population are poorly described. In this report, we describe the treatment of a population of very elderly patients with NSCLC at a large teaching hospital.

A retrospective chart review was performed of 111 outpatients with NSCLC aged 80 or older. Patient treatment regimens were evaluated for consistency with contemporaneous stage-specific guideline-recommended therapy (GRT). Attention was paid to how patient characteristics and attitudes influence therapy decisions.

Patients characteristics included median age of 82.6 years (range, 80-92), 30% stage I-II, 39% stage IV, 59% performance status 0-1, 25% performance status >or=2 (performance status unavailable for 15%). Eighty-four percent of the patients received some form of antineoplastic therapy, and 11% were treated with best supportive care alone. Of 34 patients with localized disease, 53% underwent tumor resection and 38% received definitive radiation. Of 70 patients with stage III or IV disease, 36% received cytotoxic chemotherapy and 27% received oral targeted therapy alone. Thirty-two percent of patients received the stage-specific GRT. Of the patients who did not receive GRT, 26% electively refused the offered GRT and 74% were not offered GRT.

The vast majority of octogenarian patients with NSCLC receive antineoplastic therapy, but only one third of this population receives stage-specific GRT. Although many patients choose aggressive therapies, a small but clinically significant portion chose not to receive the offered GRT. More data are needed on appropriate therapy recommendations for this patient population.