This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #21, #22, #27, #28
Become familiar with the general principles of lung cancer evaluation and its inherent need for a multidisciplinary approach to management.
Identify the broad treatment paradigms for different stages of lung cancer, including more recent developments in therapeutics, and their potential risks and complications.
Discern geriatrics-oriented issues in the multidisciplinary care of older adults with lung cancer and apply geriatric assessment and palliative care principles to their care trajectory.
Key Clinical Points
Lung cancer remains a cancer of older adults and confers substantial morbidity and mortality in an aging patient population.
Although advances have been made in molecular diagnostics and therapeutics for a select group of patients with advanced nonsmall-cell lung cancer (NSCLC), the risks of cytotoxic chemotherapy among other modalities have to be apprised on an individual basis.
Given the trade-offs of various lung cancer treatment options and poor prognosis in most patients with advanced disease, geriatricians play a key role in helping older adults with lung cancer and their caregivers define goals of care, optimize the management of geriatric syndromes and comorbid conditions, and better assess functional, cognitive, and psychosocial reserve to undergo treatment.
Early integration of palliative care improves mood and quality of life and may prolong survival in patients with advanced NSCLC and such interventions may be particularly relevant in older adults.
EPIDEMIOLOGY AND RISK FACTORS
Lung cancer remains the second most common cancer diagnosis and the most common cause of cancer deaths among men and women in the United States. In 2014, it is estimated there will have been 224,210 new cases of lung cancer with 86,930 men and 72,330 women dying from their disease. The median age at lung cancer diagnosis is 70 and the American population greater than or equal to 65 years is predicted to increase to over 20% by the year 2030. This combination of a burgeoning geriatric oncology population and newly recommended annual low-dose computed tomography (CT) scan screening will likely increase the number of older patients needing evaluation and treatment for lung cancer. Despite advances in screening, diagnosis, and treatment, the majority (80%) of lung cancer is diagnosed with either spread to regional lymph nodes or distant sites (ie, stage III or IV). More patients die from lung cancer than from colon, breast, and prostate cancers combined.
The major modifiable risk factor for the development of lung cancer is tobacco use, accounting for approximately 80% of lung cancer cases. Smokers and nonsmokers are at risk for lung cancer; however, the risk is much higher (10-fold) among patients who have smoked cigarettes. The risk is directly proportional to the number of pack-years and tar content. Patients exposed to passive tobacco smoke are also at risk, accounting for 25% of lung cancer cases. Men or women who smoke cigars ...