Adjuvant Chemotherapy in Elderly Patients with Non-Small-Cell Lung Cancer

Cesare Gridelli, MD, Paolo Maione, MD, Daniela Comunale, MD, and Antonio Rossi, MD


Cancer Control. 2007;14(1):57-62. 

In This Article

Comorbidities and Frailty

It has been reported that among individuals aged 65 to 74 years, the mean number of chronic diseases is 6. The prevalence of these comorbid conditions is about twice as high as in the general population.[10] More than half of patients in this age group have chronic arthritis, 33% have backache, 32% have visual deficit, and 28% have exertional dyspnea.[11] Preliminary observations also confirm the coexistence of other diseases in elderly cancer patients.4 The most important coexisting pathologies in lung cancer patients are cardiovascular and pulmonary diseases, which are common among heavy cigarettes smokers.

Another important issue is the definition of frail elderly persons. Frailty is a condition in which most functional reserve is exhausted. Frail patients depend on others for the activities of daily living primarily due to physical and cognitive dysfunctions. Generally, chemotherapy should be avoided in patients with advanced NSCLC, given the high risk of toxicity. Reliable information regarding a patient's comorbid health problems is mandatory to plan an appropriate treatment. Comorbidity influences treatment choice globally and is a predictor of outcome.[12] However, to date, a standard, fully satisfactory method of assessing comorbidity has not been defined.[13] Moreover, few authors report the number of comorbid conditions for patients entering clinical trials, and there are limited reports that take into consideration the degree of severity of comorbidities.[14]

To plan optimal treatment, a multidimensional geriatric evaluation must include not only comorbidities assessment but also functional, mental, and nutritional status. Table 1 lists the principal multidimensional assessment domains and tools. Recent studies have reported the prognostic value for overall survival of baseline assessment of functional status, comorbidity, and quality of life in 566 elderly patients with advanced NSCLC treated with chemotherapy.[15] Functional status was measured as activities of daily living (ADL) and instrumental ADL (IADL). Scores for pretreatment global quality of life and IADL, but not ADL and comorbidity, showed a significant prognostic value for survival of elderly patients with advanced NSCLC who were treated with chemotherapy. Using these scores in clinical practice might improve prognostic prediction for treatment planning.

As a consequence of the factors noted above, elderly patients with NSCLC, who frequently suffer tumorrelated symptoms and need some type of palliative treatment, often receive untested or inadequate treatments.[7,16] This occurs more often in elderly patients than in their younger counterparts. Furthermore, the elderly are not generally included in clinical trials.[17]