8 Facts About Lung Cancer in Older Adults: Treatment Options, Prognosis, and More | MyLungCancerTeam

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8 Facts About Lung Cancer in Older Adults: Treatment Options, Prognosis, and More

Medically reviewed by Leonora Valdez, M.D.
Written by Joan Grossman
Posted on June 6, 2024

If you’re an older adult with lung cancer, you might have specific needs related to aging. It’s important to understand how lung cancer affects older people to be sure that you receive the best possible care.

    Talk to your cancer care team about how best to manage lung cancer as an older person in terms of treatment, prognosis, and quality of life. Here are some key facts you can discuss further with your oncologist.

    1. Lung Cancer Mostly Affects Older Adults

      The prevalence (commonness) of lung cancer is highest among older people. According to the American Society of Clinical Oncology, more than half of people with lung cancer are diagnosed after the age of 65, and 30 percent of those diagnosed with the disease are over 70. Because of the advanced age of most people with lung cancer, almost 70 percent of older adults in the United States are likely to have at least two other chronic conditions that may affect treatment and prognosis (likely outcome).

      For older adults, factors like frailty, falls, mental function, and hearing or vision impairment can be made worse by lung cancer. Additionally, because lung cancer requires significant care and attention, older adults might be at a higher risk of neglect if their caregivers are unable or unwilling to provide the necessary support. These issues can affect how well your cancer is treated and may have an impact on your lifespan.

      2. The Risk of Lung Cancer Increases With Age

        The incidence of lung cancer increases as people get older. Per Cancer Research UK, the highest risk is between ages 75 and 79 for women, and men have the highest rates of lung cancer between the ages of 85 and 89. DNA in our cells is damaged as people age, and exposure to risk factors such as smoking, air pollution, some chemicals, and asbestos can further raise the risk of developing lung cancer. Smoking is the leading risk factor for lung cancer in men over 65.

        Some health conditions that affect the lungs can also increase the risk of developing lung cancer in older people, including asthma and chronic obstructive pulmonary disease (COPD).

        3. Older Adults Often Aren’t Treated for Lung Cancer

          Research shows that older people are less likely to receive care for lung cancer than younger people and sometimes may not even be offered treatment. One problem is that elderly patients are often not included in clinical trials. Clinical trials are studies that can provide a better understanding of lung cancer treatment and overall survival rates among older people. Clinical studies can also help doctors develop better practice guidelines for older adults.

          In one study published in the journal Cancer, almost 63 percent of people aged 80 or older with stage 3 non-small cell lung cancer received no treatment. In addition, older adults with advanced-stage lung cancer who only received radiation (radiotherapy) had poorer outcomes than those who received both radiation and chemotherapy.

          Disparities (preventable differences) were also found with other groups who received treatment at a lower rate than average, including Black people with lung cancer and people with less education.

          Medical researchers have acknowledged that prejudice against treating people with lung cancer based on age — or any prejudice for that matter — is no longer considered appropriate. Older people whose overall health is good should be offered standard treatment options when appropriate, including radiation, chemotherapy, immunotherapy, and targeted therapy.

          4. Cancer Treatment Can Be Successful Even at Very Advanced Ages

            Recommended treatment options can vary for older people with lung cancer, depending on overall health and type of lung cancer.

            However, one large study showed that treatment of non-small cell lung cancer (NSCLC) in people aged 90 or older with early-stage lung cancer had significant benefits. Those who had treatment for stage 1 lung cancer improved their prognosis and survived on average more than 27 months. Those without treatment survived on average 10 months.

            5. Having Other Health Conditions Can Affect Lung Cancer Survival

              People with lung cancer have a higher risk of developing comorbidities (two or more conditions at the same time). This is because of the strong association of lung cancer with smoking and because so many people with lung cancer are older. Common comorbidities include chronic obstructive pulmonary disease (COPD), heart disease, diabetes, and liver disease.

              Comorbidities have been found to mask lung cancer symptoms and delay a cancer diagnosis, causing a delay in treatment for lung cancer. Furthermore, people with lung cancer, whose health is seriously affected by another disease, may not be candidates for aggressive lung cancer treatment.

              6. Older People Have More Serious Side Effects From Chemo

                Although the side effects of chemotherapy are similar for older and younger age groups, older adults are more likely to have more side effects and side effects that are more severe. Chemotherapy drugs affect the whole body, and older people are more likely to have other conditions that weaken their body, along with weakness that comes with aging.

                Oncology research from the National Cancer Institute has shown that a geriatric assessment can help with chemotherapy treatment decisions for older adults and reduce side effects and toxicity (harmful effects) for some people. A geriatric assessment focuses on thoroughly reviewing health issues in elderly people to have a full picture of factors that may affect treatment choices and potential side effects.

                7. Palliative Care Can Help With Treatment Side Effects

                  Palliative care is supportive care that can help with pain and discomfort at any stage of lung cancer. Palliative care teams aim at easing symptoms and side effects of any other type of cancer. For older adults with lung cancer, palliative care can be especially helpful because the side effects of chemotherapy can be more intense in older people. Older adults with lung cancer may also need more support when recovering from lung cancer surgery.

                  Depending on someone’s particular condition, palliative care teams can include doctors, nurses, social workers, pharmacists, mental health practitioners, and nutritionists, among others. This kind of supportive care can provide interventions for both physical discomfort and emotional stress that can occur when living with lung cancer, including anxiety, depression, and problems with sleep.

                  Sometimes, palliative care is confused with end-of-life hospice care, which is offered when someone is no longer undergoing oncologic treatment for lung cancer. Palliative care can help keep you comfortable while you are undergoing treatment or if you’re not currently getting treatment.

                  8. It’s Important To Advocate for Yourself or a Loved One if You Need Lung Cancer Treatment

                    If you or a loved one is an older adult living with lung cancer, it’s essential to communicate openly with your health care team about your treatment priorities and goals. Let your doctors know that you want to share decision-making about your treatment.

                    If you feel you haven’t been offered treatment options because you are older, you can advocate for yourself to help ensure you get the best possible treatment and care, along with help while managing treatment side effects.

                    Your cancer care team is obligated to provide you with information about treatment options and answer questions about which treatment plans may be appropriate for you. It’s important to prepare ahead of time for visits with your doctors.

                    Bring a list of questions to your doctor visits so you don’t forget to ask about something that may be important. Have a family member, caregiver, or friend come with you and take notes. They can also back you up with any questions you may not have written down that could affect your treatment decisions.

                    If you need supportive care or want to know more about it, your health care providers can give you information about where palliative care may be available and how you can access it.

                    Talk With Others Who Understand

                    MyLungCancerTeam is the social network for people with lung cancer. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

                    Do you have questions about cancer care for older adults? Have you had palliative care? Share your experience in the comments below, or start a conversation by posting on your Activities page.

                      Posted on June 6, 2024
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                      Leonora Valdez, M.D. received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute. Learn more about her here.
                      Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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