Treatment for NSCLC in elderly patients based on detailed functional evaluation

This study tested the efficiency of allocating cancer treatments to elderly non-small cell lung cancer patients based on comprehensive geriatric assessment (CGA). The authors concluded that allocating cancer treatment based on CGA had no difference than current standard allocation methods.

In elderly patients with advanced non-small cell lung cancer (NSCLC), treatment type is allocated based on age and performance status (PS – mild, moderate, or severe symptoms). Fit patients receive treatment with two chemotherapy agents, while less fit patients receive single agent therapy. However, factors for classing a patient as fit or less fit need to be defined further.

CGA is used to evaluate elderly patients medically, functionally and psychologically. It takes into account cognitive (thought) capabilities, emotional status, other diseases, nutrition, and environmental and social situations. It is not clear as to whether including CGA when deciding on cancer treatment would be beneficial to elderly patients.

494 patients were enrolled in the study. 251 patients were given treatment based on standard methods (PS and age). Of these, 35.1% of these patients were fit enough for double agent chemotherapy and the less fit 64.9% received single agent chemotherapy. 243 patients were given treatment based on CGA. Of these, 45.7% were fit enough for double agent therapy, 31.3% less fit patients received single agent therapy and 23% of very frail patients received best supportive care (managing disease symptoms without chemotherapy).

The study found no difference between the two groups in terms of overall survival, progression free survival (time from beginning treatment and disease progression), treatment failure free survival (time from treatment beginning and treatment discontinuation) or overall treatment response rate.

Patients receiving treatment based on standard allocation methods had significantly more side effects, including neutropenia (decreased levels of white blood cells), anemia (decreased levels of red blood cells) and fatigue.

This study concluded that deciding on treatment for elderly patients with advanced NSCLC based on CGA had no difference in effectiveness compared to current allocation methods. Decisions based on CGA led to fewer toxic side effects. 

Discuss with your doctor the appropriate way to determine the most effective treatment course.