Background 40% of cases of lung cancer are diagnosed in patients aged 75 years and over. Comorbidities, frailty and poorer tolerance of therapy are challenges for diagnosis and management. We explored clinical outcomes and survival in a cohort of elderly patients in which a tissue diagnosis was pursued.
Methods 43 patients aged 75 and older who attended between 01/11/2013 and 30/04/2014, where a West Glasgow MDT decision was made to pursue tissue diagnosis were identified from audit data. Survival was reviewed at April 2015.
Results Mean age was 80 ± 4 yrs; 21 male/22 female; WHO Performance Status (PS) of 0 (2 pts), 1 (27 pts), 2 (5 pts), 3 (5 pts), Not Documented (4 pts). 17 patients had Bronchoscopy +/- EBUS-TBNA, 19 CT-guided lung biopsy, 5 other core biopsy, 2 positive pleural aspiration. Histology was non-small cell lung cancer in thirty-two (74%) patients, small cell lung cancer in three (7%) patients, mesothelioma in three (7%) patients, other malignancy in 3 (7%) patients and non diagnostic in 2 patients (diagnosis registered as clinical lung cancer). Seventeen (40%) patients were treated with curative intent (surgery, radical radiotherapy, chemotherapy for SCLC), sixteen (37%) patients with palliative intent (radiotherapy, chemotherapy, brachytherapy), and ten (23%) patients received best supportive care (BSC) only. Of the five patients with PS 3, one received palliative radiotherapy and the other four BSC. Patients treated with curative intent had 71% survival at six months, 65% survival at 12 months: survival rates significantly higher compared with those receiving palliative treatment or BSC (p = 0.02). There was no survival difference between palliative treatment and BSC (p = 0.81) (Figure 1).
Conclusion When a tissue diagnosis of lung cancer is pursued in those aged 75 and older, most patients will receive specific cancer treatment and this data informs clinical discussions about curative intent outcomes. In those who are PS 3 at baseline, BSC only is the likely outcome, and pursuing tissue diagnosis may not be appropriate.