Management of non-small-cell lung cancer in the older adult

The treatment of older adults with non-small cell lung cancer (NSCLC) poses special challenges for the clinician. Older adults are more likely to have decreased functional reserve which might limit their ability to undergo surgery or receive chemotherapy. Additionally, age is associated with increased number of co-morbid medical conditions that could be exacerbated by treatment and could predispose to poor outcome. It is unclear how these propensities affect the efficacy and safety of therapy in older patients with NSCLC, as the elderly are an understudied population and there are limited data in older adults in most trials evaluating therapy in lung cancer. As the number of trials of older adults increases, however, it is becoming more evident that age alone cannot be used as a surrogate for poor outcome. Various studies have shown that older adults are able to benefit from surgery or chemotherapy when correct patient selection is used. Most chemotherapeutic regimens have similar efficacy in older and younger patients, and while some toxicity rates are higher in older patients, with appropriate prophylaxis and supportive care older adults are generally able to tolerate most chemotherapy regimens, even in combinations. Proper selection of candidates for aggressive therapy is important, and identification of issues that might limit ability to complete treatment or benefit from treatment is essential, and can be accomplished through the use of a comprehensive geriatric assessment. This article serves as a review of the available evidence in the evaluation, treatment, and support of the older adult with cancer.