Older Age Is Not a Limiting Factor for Lung Cancer Surgery

By Jim Stallard,

Doctor and patient looking at x-ray of lungs.
Summary

Older patients are sometimes reluctant to have surgery for lung cancer because they mistakenly believe the risk outweighs the benefits. A new study shows that older patients who receive surgery at MSK usually survive their lung cancer for more than five years and are more likely to die from a non-cancer-related cause.

Highlights
  • Surgery is effective for early-stage lung cancer.
  • Older patients sometimes opt for other treatments.
  • Older patients usually survive more than five years after surgery.
  • Age should not be a limiting factor.

Although lung cancer is generally perceived to have a poor prognosis compared with other cancers, surgery has proven to be effective at increasing survival in those diagnosed at the earliest stage. However, older patients diagnosed with early-stage lung cancer often do not get surgery because they — along with their family members and primary care physicians — think that risks associated with surgery outweigh benefits in extending life, and are instead offered palliative treatments.

This is a mistake, according to a study led by Memorial Sloan Kettering physician-scientist Prasad Adusumilli and published recently in the Journal of Clinical Oncology. The researchers found that older patients with early-stage lung cancer who receive surgery at MSK — even those over 75 — usually survive their cancer for longer than five years and are more likely to die from a non-cancer-related cause, such as heart disease.

“Patients should not be denied surgery simply because of their age,” Dr. Adusumilli says. “There has been a misconception about the usefulness of surgery in older lung cancer patients because of other factors that lower the chances of survival. But we’ve shown in our patients that surgery can be quite effective in curing the disease.”

Patients should not be denied surgery simply because of their age.
Prasad S. Adusumilli
Prasad S. Adusumilli physician-scientist

The study looked at more than 2,000 patients with stage I non-small cell lung cancer (NSCLC) — the most common type of lung cancer — who received surgery at MSK to remove their tumor. About 70 percent were 65 years or older, and about 30 percent were at least 75. Among the patients who did not die during the first two years after surgery, the five-year survival rate was close to 90 percent. Those who died during the first two years were more likely to die from non-cancer-related causes.

The new study provides much-needed clarity on how surgery affects older lung cancer patients. Previous research has mostly looked at either whether the cancer returns or overall survival regardless of what might have caused the death. Focusing solely on lung cancer–related deaths showed surgery’s true effect on early-stage disease.

“Considering that nearly one-third of the patients in this study were 75 years and older, we have strong evidence that age does not have to be a barrier,” Dr. Adusumilli says. “We weren’t selecting for younger or healthier patients to get good results. Most of the patients over 75 years had other health conditions such as emphysema, heart disease, or kidney disease.”

Expertise in Elderly Care

Dr. Adusumilli explains that MSK patients benefit from surgeons who have expertise in treating older patients. If a patient is over 70, they are referred to the Geriatrics Service, which can address the special needs of this group. MSK patients also receive the careful attention of heart and lung specialists, nurses, and respiratory therapists, both during their hospital stay and after they go home. This expertise plays an important role in enabling lung cancer patients to maintain their health and mobility.

By measuring patients’ lung function before surgery, doctors can calculate how well they will do after part of a lung is removed. Patients actually need only 40 percent of total lung function in order to perform virtually any activity.

“We offer surgery for these patients only if we can assure them that their quality of life is going to be the same within a month after the operation — that they will function as well as when they first walked into our clinic,” Dr. Adusumilli says.

He explains that the findings are especially important considering the growing number of older people in the population, due to increasing life spans.

“This is the population we’re going to treat increasingly going forward,” he says. “In these patients, it’s important we use a surgical treatment that is curative and safe, in both the short and long term.”

Comments

My wife has stage 4lung cancer which has responded to chemo and radiaton. My Question is can surgery be done with the same kind of outcome onstage 4 it is in the left lung and all metastasis are now gone..nd tumor in lung has shrunk 50%.

Joseph, thank you for reaching out. While patients can be considered for surgery following a good response to chemotherapy and/or radiation, the decision is made on a case-by-case basis, as every patient's condition is affected by a large number of factors. If your wife would like to make an appointment for a consultation with a Memorial Sloan Kettering physician, she can call our Physician Referral Service at

800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment

Thanks for your comment.

A friend of mine had a lobe removed from his lung due to cancer..He is a very active person. He just had it done a day or so and now he wants to go and do all sorts of things I told him he has to rest and take care of himself..He is very stubborn ..Any advice..Thank you..

Marlene, thank you for reaching out. Your friend really should consult with his medical team about recommended levels of activity following surgery, as it differs depending on many factors, including age and physical condition.

I have no definitive diagnosis yet there is a mass on my lung they are saying its pneumonia . But not sure organized vs not organized Re scan after antibiotics , I have history of lung nodules stable then this popped up . Im a resident of Middletown for years . My question is they arent sure !! Talking about needle biopsy if no resolve cant find a pulmonary doc that will see me right away . Do you have services like a radiologist or oncologist that can make a diagnosis ? Im 55 years young

Dear Linda, we're sorry to hear you're going through this. If you would like to make an appointment at MSK-Monmouth, you can call 848-225-6000 or go to https://www.mskcc.org/locations/directory/msk-monmouth to request an appointment online. Thank you for your comment, and best wishes to you.

Please help, I am desperate for advice on whether to even put my Aunt through a lung bx. I live in TX and coming back & forth to NY to help. She is 84 years old, 1 ppd/smoker for 60+ years, diabetic but A1C good, no meds, HTN, CAD but no known cardiac events with regular 12lead suggestive of anterior MI. She gets around very well, clear BBS without SOB and good air movement. Had left upper lobe mass dxd on pre-cardiac cath CXR done due to atherosclerosis, followed by CT chest then PET. Radiology inmpression:
1. FDG avid lobular mass LUL indicative malignancy
2. Non-calcified nodule RUL w/mild metabiolic activity differential infectious/inflammation vs. less active malignancy

Her bx is scheduled on 9/9/18 at North Shore U/Manhasset with an IR. Would there likley be tx/ She wouldnt go for chemo. Is surgery an option with her age and potential cardiac risk? They never did cath once CXR found mass.

Dear Diana, we're very sorry to hear about what your aunt is going through. Unfortunately, we are not able to provide medical advice on our blog. However, you may wish to speak with someone at MSK about scheduling a consultation to get a second opinion. The number to call is 800-525-2225. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment, and best wishes to you and your aunt.

I have been getting intermittent pain in my left upper breast bone. Never a smoker. But around second hand smoke as a child to teens. When I touch the rib it feels like black and blue. I get a cough that’s intermittent to. Not all day. Upon extertion of certain things. Also ymhave pain in the area directly behind the chest pain in the upper back. Feels as if my neck is still or a muscle is being pulled. Afraid I may have a tumor in my upper lung next to my esophagus. I have had a few chest X-rays in the past 2-7 years afraid of more radiation to that spot. Do you think it could be a tumor. I have also heard of costachondritis. Sp? Thanks.

Dear Joanne, we recommend that you speak with your doctor about this. Thank you for your comment, and best wishes to you.

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