Read PDF Management of Lung Cancer in Older People (Management of Cancer in Older People)

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These can include nausea, vomiting, diarrhea, and dehydration. Dehydration is not having enough fluids for your body to work well. Nervous system damage. It can also increase memory loss, make you tired, and cause nerve damage. Older adults are more likely than younger people to take regular medications for other health conditions. These medications might affect the chemotherapy you receive.

Key points

Or chemotherapy might affect how your regular medications work. To help prevent problems, make a list of all your medications.

This includes those that are taken without a prescription as well as vitamins, supplements, and herbs. Be sure every medication is listed, even medications that are not taken daily. Share this list with your health care team.


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Radiation therapy might be your only treatment. Or you might have it in addition to surgery or chemotherapy. You usually do not stay in the hospital for radiation therapy. But you might need to go for treatment often, sometimes every day for several weeks. Radiation therapy can come from a machine outside the body. Or your doctor may put tiny pieces of radioactive material inside your body, near the tumor. Depending on your health, your doctor might recommend less intense treatment for a shorter time than for someone younger. Older adults usually do well with radiation therapy.

The side effects depend on the type and dose of radiation therapy and where the cancer is. For example, radiation therapy for prostate cancer can cause different side effects than radiation therapy for head and neck cancer. Learn more about radiation therapy for specific types of cancer types. Clinical trials are research studies that involve people. The people in clinical trials volunteer to help researchers learn more about new drugs and treatments. Doctors need to learn which treatments work best in older adults.

They also need to learn if those treatments might work differently than in younger people. Talk with your health care team about available clinical trials and how they differ from standard treatment.

Support Groups

This is called palliative care or supportive care. It can be especially important for older adults. This is because older adults can have more side effects, especially from chemotherapy. Or your body may not recover as quickly from surgery as someone younger, which can cause more symptoms. Palliative care also includes getting all the support you and your family need during cancer. Anyone can receive palliative care at any time.

It is important to ask for support when you need it. Advanced cancer is cancer that doctors cannot cure. It is also called end-stage cancer or terminal cancer. Even though your health care team cannot cure advanced cancer, they can treat it. And you can still have a good quality of life. Hospice Care. This is care to help you and your family cope with death and dying. It is available when you are no longer having treatment to cure your cancer. Understanding these types of care can help you and your health care team plan for your needs, goals, and wishes. Learn more about advanced cancer.

After you learn about your treatment options and your general health, you might need more information. Consider asking your health care team the following:. Will I need to be in the hospital for treatment? Or can I stay home and come to the hospital or clinic during the day?

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If I am worried about managing the costs related to my cancer care, who can help me with these concerns? Why your decisions matter In the past, doctors sometimes made decisions without talking with patients. What to consider Before making any treatment decisions, talk with your health care team about: The type of cancer, if it has spread, and how far All your treatment options, and the risks and benefits of each one Any other medical conditions that might cause problems with treatment or increase your risk of side effects How cancer treatment can affect your physical health, emotional health, and lifestyle Thinking about your personal situation is also very important.

You might want to consider: Possible emotional and social challenges. Think about each of the areas listed below: Physical comfort Relationships Nutrition Ability to keep taking care of yourself, do usual activities, or live independently Financial security Having a meaningful life Your ideas about a dignified or peaceful death It is important to talk honestly with your health care team about what quality of life means to you. Learn more about making decisions about cancer treatment.

Your cancer treatment goals Your cancer treatment goals depend on many factors. If you and your family do not agree Family members, friends, and caregivers might have different ideas about your treatment. Cancer treatment options for older adults You may have just one type of treatment or a combination of treatments.

Cancer Care Decisions for Older Adults

The main cancer treatments for people of all ages are: Surgery Chemotherapy or targeted therapy Radiation therapy How cancer surgery can affect older adults Like other treatments, surgery has risks. Before surgery, you and your doctor should think about the following: Heart function. Considering surgery risks and benefits It is important to talk with your health care team about the risks and benefits of cancer surgery. Learn more about cancer surgery. Planning for after surgery Talk with your health care team about the care you need after surgery.

Ask if you might need: A home health aide A visiting nurse Physical therapy A social worker Support groups Recommendations for help in your community Planning for your after-surgery care is important.

How chemotherapy can affect older adults Unlike surgery, chemotherapy can take a long time. Side effects of chemotherapy Unlike radiation therapy and surgery, chemotherapy affects your whole body. Grade 5 adverse events occurred in 9. Therefore, whether platinum-doublet chemotherapy is effective and tolerable for a wide range of age groups remains unclear. S-1 is an oral anticancer agent comprising of tegafur, gimeracil, and oteracil at a molar ratio of The preclinical synergistic activity of S-1 with RT and its favorable toxicity profile have led to clinical trials that evaluated S-1 in chemoradiotherapy regimens in elderly patients mainly in Japan Table 2.

Hasegawa et al. The overall response rate was These combinations seem not feasible for elderly patients because of a high incidence of sever pneumonitis. The efficacy of doublet drug in combination with RT in elderly patients was investigated. Although this combination regimen demonstrated good feasibility and safety, a clinically significant survival benefit was not provided.

Niho et al. Twenty-eight patients were enrolled in this study. The median age was 77 years range, 71—83 years. The response rate was The median OS was Although carboplatin plus S-1 and concurrent thoracic RT had promising efficacy in elderly patients with locally advanced NSCLC, radiation pneumonitis was frequently observed with the therapy as compared with single-agent chemotherapy carboplatin or S The median survival was No treatment-related deaths occurred, but 31 It was not an elderly-specific trial.

The addition of cetuxumab to chemoradiotherapy did not provide any survival benefit while increasing toxicities. The median PFS was The safety profile was similar between the arms.

Management of Advanced Lung Cancer in the Elderly: A Reason to Rejoice or a Cause for Concern?

The most common grade 3 or 4 adverse event was pneumonia 4. A subgroup analysis revealed a PFS benefit with durvalumab across all prespecified prognostic factors. The HR by age was 0. Attention must be paid to immune-mediated adverse events. Diagnostic tools are needed to accurately judge the status of elderly patients to identify the suitable treatment.

Analysis did not show any statistically significant differences in median OS between fit and medium-fit patients treated with cCRT We did not observe differences in grade 3—4 haematologic toxicity between fit and medium-fit patients or between vulnerable and non-vulnerable patients. Four 3.

All treatment-related deaths occurred in the medium-fit group: two due to radiation pneumonitis and two due to respiratory infection.