Surgery improves survival in this demographic of patients with NSCLC

Surgery in nonagenarians to treat early stage lung cancer boosts chances of 5-year survival, according to the results of a study published in The Annals of Thoracic Surgery. 

“Many patients in the [United States] who are 90 years and older with lung cancer are not receiving any therapy, yet treatment in this older population is often associated with better overall survival,” noted study author Chi-Fu Jeffrey Yang, MD, Stanford University, CA.

Dr. Yang and colleagues mined the National Cancer Database from 2004 to 2014 for records of patients who were at least 90 years old with stage I-IV non-small cell lung cancer (NSCLC). In total, 57.6% of these patients received no treatment for lung cancer. In those who did receive surgical treatment, however, odds of 5-year survival jumped from 1.7% to 9.3%.

Only 11.7% of patients with stage I NSCLC underwent surgery, while 32.9% received no therapy at all. Among the 1,430 who were treated for stage I NSCLC, surgery offered the greatest benefit, with 33.7% living an additional 5 years compared with 17.1% in those who received non-operative treatment and 6.2% in those who received no treatment.

“It is unclear why patients are not receiving therapy, but we speculate that ageism may be a factor,” said Dr. Yang. “We are particularly concerned that healthy, otherwise fit patients are not being recommended any type of treatment simply because they are 90 years and older. It may be possible that some physicians think that treatment might not make much of a difference for these much older patients, but our study suggests that elderly patients with lung cancer who receive curative-intent, standard-of-care treatment in a multidisciplinary setting can have better outcomes than what you might have initially expected.”

Dr. Yang and colleagues are worried that in the real word, physicians who serve nonagenarians may not be recommending surgical treatment due to bias and regardless of healthy status or early stage disease. Dr. Yang recommended that these patients receive the same “thoughtful and compassionate medical and surgical care as younger patients.”

Although the authors are not suggesting that every nonagenarian with NSCLC receive surgery, many of these patients can cope with surgery with little compromise to quality of life. Dr. Yang stressed that treatment alternatives for these patients should be determined in a robust and multidisciplinary capacity, with the involvement of a lung cancer tumor board, thoracic surgeons, and radiation oncologists, as well as the patients themselves.

Per Dr. Yang: “Although patients may already have an idea of what their treatment preferences would be, we encourage patients and their families to seek evaluation by specialists to hear about the details, risks, and benefits of treatment before finalizing decisions regarding their care. Surgery in carefully selected patients may not only be reasonable, but also an optimal therapy.