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Lung cancer • 7: Management of lung cancer in elderly patients
  1. R Booton1,
  2. M Jones2,
  3. N Thatcher1,2
  1. 1CRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester M20 4BX, UK
  2. 2Regional Cardiothoracic Centre, Wythenshawe Hospital, Manchester M23 9LT, UK
  1. Correspondence to:
    Professor N Thatcher, CRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester M20 4BX, UK;

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Denying the elderly important advances in the treatment of lung cancer on prejudice alone is no longer justified. The fit elderly person with adequate organ function should be offered similar treatment to younger patients. Other elderly patients should ideally be included in randomised trials to provide an evidence base.

The peak incidence of lung cancer in the UK is between 75 and 80 years of age, reported at 751 per 100 000 in men over 75 years,1 with over half of 500 000 patients diagnosed annually worldwide being over the age of 70.2,3 It is therefore an enormous health burden on our ageing populations and will, in the medium term, pose a significant challenge to health services worldwide as the age distribution of the population skews towards the octogenarian. Sufferers of lung cancer can expect a high symptom burden, particularly from fatigue and breathlessness,4,5 together with the highest rates of co-morbidities found among all tumours6,7—including cardiovascular disease (23%), chronic obstructive airways disease (COPD) (22%), and other malignancies (15%).7 Indeed, the prevalence of co-morbidity among lung cancer sufferers is significantly higher in patients aged >70 years, together with a proportionate increase in the number of co-morbidities per patient.7,8 In patients with stage IV non-small cell lung cancer (NSCLC), increasing co-morbidity is associated with a reduction in the percentage of patients receiving chemotherapy.9 The most frequent co-morbid combinations were COPD with cardiovascular disease (17%), COPD with other malignancy (13%), and COPD with hypertension (11%).7 In a recent review of 966 patients with lung cancer and median age 70 years, COPD and combined cardiac and cerebrovascular disease were diagnosed in 7.6% and 26.3%, respectively, each correlating adversely with survival (p=0.0275 and p=0.0466, respectively, compared with performance status and stage, both …

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