Table of ContentsView AllTable of ContentsToleranceEarly StageOptions for Locally Advanced Lung CancerAdvanced or MetastaticFactors in Decision Making
Table of ContentsView All
View All
Table of Contents
Tolerance
Early Stage
Options for Locally Advanced Lung Cancer
Advanced or Metastatic
Factors in Decision Making
Unfortunately, many people don’t realize this. Research shows that patients in this age range are less likely to receive treatment. In one study, close to two-thirds of patients 80 and older don’t receive any treatment after being diagnosed withstage 3 lung cancer.
Yet age alone is not a reason to forego treatment. Options for early-stage and, potentially, even advanced-stage lung cancer treatments can effectively give you more and fuller years of life.
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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 considered forstage 1and somestage 2NSCLC, as well as some limited-stage small cell lung cancer (SCLC).
Locally advancedlung cancer treatment options are used with some stage 2 and stage 3 NSCLC and extensive SCLC.
Treatment foradvanced lung canceris offered for those with metastatic lung cancer, which occurs in some stage 3 andstage 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 treatments for late stages, or that lung cancer treatment, in general, offers little benefit. Fortunately, even older adults can see positive results from therapies.
Options for Early Stage Lung Cancer
For people of any age with lung cancer, being diagnosed in the early stages offers thechance to cure the diseaseor reduce the risk of recurrence with surgery and/or stereotactic body radiotherapy.
While there may be a concern that surgery could be dangerous for older adults, research shows that survival rates for older patients are comparable to younger patients for various types of surgery for lung cancer.
Surgery
There are four main types of surgery that are performed in an effort to remove lung cancer cells:
Studies looking at wedge resection, segmentectomy, or lobectomy for lung cancer treatment have found that many older adults are able to tolerate the surgery quite well, and those over age 80 don’t seem to have a higher risk of complications compared to adults 10 or more years younger.
The same studies, however, found that a pneumonectomy still seems to be highly risky for octogenarians, and older lung cancer patients have significantly lower survival rates after the complete removal of a lung.
Of course, studies only report statistics, and a surgeon may have a much better idea about which type of surgery would offer you the best results based on your overall health and cancer.
It’s worth searching for a surgeon who specializes in lung cancer and has experience operating on older adults. It’s also recommended that you seek a second opinion. Consider consulting with healthcare providers at one of the largerNational Cancer Institute-designated cancer centers. To do so, you may need to travel or deal with some inconvenience, but you are more likely to find a health professional with expertise that matches your specific needs.
VATS: Minimally Invasive Surgery
The removal of lung tissue usually is done through one of two procedures. The more traditional surgical technique is called an open procedure. An incision is made in the chest, the ribs are spread apart, 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, with the assistance of a camera, uses small instruments to operate without fully opening up the rib cage.
Specific studies of lung cancer patients over 65 show that VATS and open chest procedures have better postoperative results and similar long-term survival rates compared to open chest procedures.
What You Should Know About a Lobectomy
Benefits of Pulmonary RehabilitationPulmonary rehabilitation involves using exercises, lifestyle changes, and education to help improve shortness of breath and exercise tolerance, which can improve quality of life. As part of a complete course of treatment, it may be prescribed before or after lung cancer surgery. Pulmonary rehabilitation can be beneficial for people of all ages, but especially for older adults.
Benefits of Pulmonary Rehabilitation
Pulmonary rehabilitation involves using exercises, lifestyle changes, and education to help improve shortness of breath and exercise tolerance, which can improve quality of life. As part of a complete course of treatment, it may be prescribed before or after lung cancer surgery. Pulmonary rehabilitation can be beneficial for people of all ages, but especially for older adults.
Stereotactic Body Radiotherapy (SBRT)
If your early-stage lung cancer is inoperable, or if you prefer not to go through surgery, a targeted radiation treatment calledstereotactic body radiotherapy (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 age 90 and older.
Some lung cancer specialists now believe that SBRT should be the treatment of choice for early-stage lung cancer in people over the age of 80. In fact, the number of surgeries performed on such patients with early-stage lung cancer has steadily declined while the number of those treated with SBRT has significantly increased.
Radiofrequency Ablation
Radiofrequency ablation is another alternative to surgery. This minimally invasive procedure has shown promise in eradicating tumors.
Using just a local anesthetic, healthcare providers insert thin probes through the skin to the tumor site and then transmit high-energy waves that heat the tumor and destroy it.
In cases where there are concerns about older adults undergoing surgery, this procedure is being considered as a possible treatment.
Surgery may continue to be an option at this point. However, since there is a greater risk that the cancer will recur, other treatments may be used in conjunction with surgery or in place of it.
Adjuvant Chemotherapy
Withchemotherapy, healthcare providers inject a combination of drugs intravenously. These will act on cancer cells throughout the body.
Adjuvant chemotherapy refers to treatments that are administered after surgery to kill any cancer cells that couldn’t be removed during the operation or to rid the body ofmicrometastases, 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 75 years of age who undergo surgery for locally advanced NSCLC.
Radiation
By delivering high-energy radiation to any remaining tumors after surgery,radiation therapyalso acts as an adjunct therapy to support surgery. This seems to be an effective treatment for all age groups.
Other studies have found that chemoradiation, treating patients with both radiation and chemotherapy, improves the prognosis for older adults. The most effective method for people age 70 and older seems to be to administer radiation more than 30 days after chemotherapy.
Options for Advanced or Metastatic Lung Cancer
With stage 3B and stage 4 NSCLC, as well as extensive SCLC, surgery may be used to help manage cancer in older adults. This is not typical, however. Instead, healthcare providers will usually focus on systemic treatments that help relieve symptoms, extend life, and, when appropriate, act aspalliative care.
Targeted Therapies
Targeted therapies are medications that target specific pathways involved in the growth of cancer. These may include:
For people with non-small cell lung cancer, it’s recommended that everyone have molecular profiling (genetic testing) before treatment is started, if possible. This will allow your healthcare providers to determine whether using medications that specifically target cells with certain genetic mutations would be useful.
Treatment may also be considered (either in aclinical trial, off-label, or expanded access) for MET mutations, RET rearrangements, and HER2 mutations.
Resistance to targeted therapies almost always develops in time.However, for some mutations, such as EGFR mutations, there are now second- and third-generation medications available so that another drug can be used to control the growth of cancer.
How Lung Cancer Is Diagnosed
Immunotherapy
One of the many difficulties that come 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 the increased rates of cancer among this age group.
There is a 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 medications, known as immune checkpoint inhibitors, have been shown to improve survival outcomes in mature patients treated for advanced NSCLC.
Immunotherapy drugs that the FDA has approved for lung cancer treatment, each of which has different indications:
Imfinzi can be used alone for the treatment of inoperable stage 3 NSCLC.Imflinzi can also be used in combination with Imjudo and platinum chemotherapy to treat certain advanced metastatic NSCLC.
These medications do not work for everyone with lung cancer and may take some time to begin working. But when effective, they can result in long-term control of even advanced lung cancers.
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 administered as palliative therapy to reduce pain and improve quality of life. It is not intended to cure the disease.
Because older adults are rarely included in clinical trials for chemotherapy, there isn’t strong evidence of how effective these medications 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 that are more common in older adults, for instance, can put a patient at risk for complications from chemotherapy.
These factors should be considered when making a plan for treatment, but they should not automatically disqualify older adults from trying the treatment.Instead, the person’s individual health and goals should be considered when weighing treatment options.
Chemotherapy Side Effects and Prevention
Chronological age alone should not be what dictates one’s lung cancer treatment plan. Still, there are age-related realities that do need to be considered when you and your healthcare provider are reviewing options.
While these conditions may cause some challenges for some mature patients, they should not preclude anyone from seeking treatments that are able to be tolerated.
The Complete Picture
If you’re over the age of 70 or 80 with lung cancer, keep in mind that, to an extent, the age you act and feel is probably 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 factor into treatment outcomes.
Healthcare providers should consider other factors (beyond age) when deciding how a person will tolerate treatment, such as those covered in the comprehensive geriatric assessment (CGA). This includes:
Medical professionals who don’t know you as well as you know yourself may view the age written on your chart as more important if it’s all the information they have to work with. What this means is that you have to develop a good working relationship with your healthcare providers.
Make sure health providers are aware that you may be 85 years old but feel more like you’re 70. If you are willing to tolerate a few side effects to live longer, make sure to speak up. Also know that certain facts about your health profile may still make some treatment options ill-advised, medically speaking.
Thankfully, we live in an era of increasingly personalized cancer treatment. Take the time to learn how to be your own advocate in your cancer care, and it will help you to better navigate the challenges of living with cancer and its treatments. The knowledge may even play a role in your outcome.
A Word From Verywell
Lung cancer in older adults has become more treatable (and often better tolerated) just as with younger adults. Yet the world hasn’t necessarily caught up with these advances, and older people diagnosed with lung cancer may need to advocate for themselves and ask to learn about options. Seeking out care from oncologists who are experienced in working with older patients can help.
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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