Article and Video CATEGORIES

Cancer Journey

Search By

Doc, Am I Too Old for Chemo?
Author
dr dubey

The average age at which lung cancer is diagnosed in the US is 71. Would it be fair to say that at least half of those who are diagnosed with lung cancer are elderly? How do we define “old”? How does age impact the effect of chemotherapy?

Two decades ago, analysis of “older patients” who received chemotherapy for advanced lung cancer revealed that chemotherapy improved survival in the elderly to the same extent as in patients who were younger. The down side was that older patients experienced more side effects from chemotherapy. It is easy to see how this result could lead to mixed feelings: live longer, but with side effects. In the 1990’s clinical trials directed towards the elderly began. The pivotal trial was called ELVIS (Elderly Lung cancer Vinorelbine Italian Study). This study compared the effect of chemotherapy (vinorelbine) against no chemotherapy in lung cancer patients ≥70 years of age. This direct comparison clearly demonstrated that chemotherapy not only improved survival but most importantly, quality of life.

How was this possible? We all recognize that controlling the cancer will control cancer related symptoms. The challenge with treatment is balancing the side effects of chemotherapy against the benefit gained by controlling lung cancer symptoms. However, vinorelbine (Navelbine) is a well tolerated chemotherapy that made it possible to improve quality of life. Subsequently, more trials in more modern times with more modern chemotherapy have repeatedly shown us that chemotherapy is feasible and worthwhile in the elderly.

Moving to early non-small cell lung cancer, post operative chemotherapy is the standard of care. The JBR10 clinical trial was one of the trials that compared postoperative chemotherapy to no postoperative chemotherapy and showed us that post-operative chemotherapy improves cure rates. This study also helped us understand the interaction of such treatment with age:

JBR.10 chemo by age

(Click to enlarge)

Patients older than the age of 65 years received less chemotherapy overall than the younger cohort, yet they benefited from post operative chemotherapy with increased survival. This study also showed us that chemotherapy did not seem to have a benefit in patients older than the age of 75, though this is a group of patients in whom deaths unrelated to cancer were common, unlike the younger population, so there were "competing risks".

The caveat to clinical trial results is that patients enrolling onto clinical trials are “fit” and extrapolating results of these trials to the “unfit elderly” has obvious flaws. As treating oncologists we recognize that more important that age is one’s “fitness” or performance status: the ability to take care of oneself, participate in physical activity, the amount of time spent resting or the amount of time spent in bed. If you wonder why your oncologist asks you how many hours in a day you sleep, it is for this reason. There are 2 scales that help us assess peroformance status. One is called the Karnofsky scale, and the other is the Zubrod scale (which is also commonly referred to as the ECOG scale):

Performance Status Scales

Years of cancer care have provided the guidelines that chemotherapy should be administered only when the performance status is good and not poor. It is this functional status scale that is the most important when making treatment decisions with the elderly, eclipsing the importance of chronologic age.

In summary, chemotherapy when carefully tailored to the fit the performance status of elderly patients does provide the benefits of improved survival and quality of life. There doesn't appear to be anything about age as a number that makes a patient "too old for chemo".

Next Previous link

Previous PostNext Post

Related Content

Image
Lung Cancer OncTalk 2023
Video
At our live event, Lung Cancer OncTalk 2023, Dr. Jeff Yang, discusses different surgical procedures used to treat early-stage lung cancer and different approaches to removing cancerous tissue from the lung. 
Image
Lung Cancer OncTalk 2023
Video
At our live event, Lung Cancer OncTalk 2023, Dr. Millie Das, discusses different Studies and Trials for NSCLC. Dr. Das specializes in the treatment of thoracic malignancies. She sees and treats patients both at the Stanford Cancer Center and at the Palo Alto VA Hospital. She is the Chief of Oncology at the Palo Alto VA and is an active member of the VA National Lung Cancer Working Group and Lung Cancer Precision Oncology Program. Learn more about Dr. Das here.
Image
The Importance of Early Detection 2023
Video
Drs. Meredith McKean, Dr. Doug Micalizzi and patient advocate and lung cancer survivor, Ivy Elkins, discuss the importance of early detection and treatment across cancer types, including skin, lung, and breast. To watch the complete playlist click here.

Forum Discussions

Hi Blaze,

 

As much as I hate to say it, Welcome back Blaze.  It sounds like you're otherwise feeling good and enjoying life which is a wonderful place to be. ...

Waiting for my appointment with oncologist this morning. Thank you for the response. It helps. <3

It sounds like you’re thinking of this in a very appropriate way. Specifically, it sounds like the growth of the nodule is rather modest, though keep in mind that the change...

Hi and welcome to GRACE.  I'm sorry your mom is having this difficulty.  An indwelling catheter is used when the pleura space continually fills and the catheter is always there to...

Hi Oaktowngrrl,  Welcome to Grace.  I'm so sorry you're going through this.

 

 Finding a reputable dedicated thoracic surgeon for lung surgery might be difficult, as it is a complex and...

Recent Comments

JOIN THE CONVERSATION
Could you
By Maeve785 on
It sounds like you’re…
By Dr West on
Thank you Janine
By blaze100 on
Hi Blaze,

 

As much as I…
By JanineT GRACE … on