Surgical treatment was found to be safe and demonstrate long-term quality-of-life benefits for carefully selected octogenarians with early-stage non–small cell lung cancer (NSCLC), according to findings from a prospective cohort study published in The Lancet Regional Health: Americas.
“As our population ages, more patients over 80 are being diagnosed with early-stage lung cancer, yet they are often not considered for surgery,” said lead study author Raja M. Flores, MD, Chair of the Department of Thoracic Surgery at Mount Sinai Health System. “Our findings show that when patients are carefully selected based on their overall health, not just their age, they can tolerate surgery well and experience excellent long-term outcomes.”
“Our study highlights the importance of making sure all patients are evaluated based on their overall health, not just their age,” said study author Emanuela Taioli, MD, PhD, Director of the Institute for Translational Epidemiology at the Icahn School of Medicine. “We must ensure that effective treatments are available to everyone who can benefit from them. Older adults are often left out of clinical decisions, but our findings show they should have equal access to care that can improve survival and quality of life.”
Background and Study Methods
Patients aged 80 years and older are increasingly being diagnosed with early-stage lung cancer as the life expectancy of the population expands. These patients are typically excluded from screening programs and clinical trials, though, due to age-related concerns of added risks.
Researchers assessed 884 patients with stage IA NSCLC from the Mount Sinai Health System in the prospective Initiative for Early Lung Cancer Research on Treatment (IELCART) study. The clinical presentation, type of surgery, postoperative outcomes, and survival outcomes were compared for the octogenarians (12.9%) vs younger patients in the cohort.
Key Findings
Octogenarians with NSCLC in the IELCART study had similar rates of comorbidities as younger patients but were more likely to receive sublobar resections (78.9% vs 62.4%; P = .030). Patients 80 years and older had higher complication rates than younger patients (40% vs 22%; P < .0001), especially cardiovascular complications. Both intensive care unit admissions and readmissions were a bit more common in the older patient group.
Physical and mental health declined at 2 months in both age groups, but improved at 1 year after surgery, with no significant differences observed.
At 5 years, overall survival rates were similar between the two age groups at 84.2% for octogenarians and 87.3% for younger patients; lung cancer–specific survival rates at 5 years were 94.4% in the older patient group and 94.5% in the younger patient group.
“We should treat the whole person, not just the number of years they have lived,” Dr. Flores said. “If a patient is strong enough, surgery can save their life.”
“Early detection and thoughtful treatment go hand in hand,” said study author Claudia Henschke, PhD, MD, Professor of Diagnostic, Molecular and Interventional Radiology and Director of the Early Lung and Cardiac Action Program (ELCAP) at the Icahn School of Medicine at Mount Sinai. “When lung cancer is found at an early stage, patients (even those over 80) can benefit from treatments that offer a real chance at a cure. This study shows that with the right approach, we can extend both life and quality of life for older adults. Additionally, screening guidelines should include patients who are over 80 years old based on these findings.”
DISCLOSURE: This study was supported by the Simons Foundation. For full disclosures of the study authors, visit thelancet.com.
