Optimal management for elderly lung cancer patients

Abstract

In the elderly, “Frailty” may become a barrier to treatment; however, the definition and diagnostic criteria thereof have not been determined. As background to this, diversity and large individual differences in the physical, mental and social functions of the elderly should be mentioned. In elderly individuals with lung cancer, it is common to conduct an evaluation mainly of organ function and cognitive function, using performance status as an indicator to comprehensively determine the suitability of treatment. As a tool to evaluate the appropriateness and tolerability of treatment for the elderly in advance, we use comprehensive geriatric assessment (CGA). As the implementation of CGA takes a long time, application thereof to both clinical studies on and routine medical care for cancer remains uncommon. Therefore, cancer-specific CGA and screening tools such as G8, VES-13 that take less time have been developed. While the aim of chemotherapy for elderly patients with non-small cell lung cancer in Japan has been to maintain quality of life (QOL), the prognosis of lung cancer patients including the elderly has been dramatically prolonged with the recent emergence of molecular targeted treatment. Specifically, due to the discovery of driver gene mutations and the development of therapeutic drugs therefor, the goal of treatment has shifted from maintenance of QOL to the prolongation of survival time. Going forward, it will be necessary to accumulate evidence on how to evaluate elderly individuals with lung cancer and carry out safe treatment, in addition to searching for a common functional evaluation of carcinomas and establishing guidelines.