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.”
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.”