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Apar Kishor Ganti, Mollie deShazo, Alva B. Weir III, and Arti Hurria

Lung cancer is a disease of the elderly, with a median age at diagnosis of 70 years. However, there is a dearth of good quality evidence to guide treatment in this population and most of the data are extrapolated from younger patients. Current research is directed toward establishing simplified instruments to quantify fitness of older patients for various forms of therapy. Although current evidence suggests that outcomes after standard therapy are similar to those seen in younger patients, older patients have an increased incidence of adverse events. Until better predictive markers are available to guide treatment, therapy should be individualized using available instruments, including a comprehensive geriatric assessment. If an older patient is deemed to be fit, it is reasonable to use the treatment options recommended for younger individuals. This article summarizes the available data on the treatment of non–small cell lung cancer in the older patient.

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Arti Hurria, Ilene S. Browner, Harvey Jay Cohen, Crystal S. Denlinger, Mollie deShazo, Martine Extermann, Apar Kishor P. Ganti, Jimmie C. Holland, Holly M. Holmes, Mohana B. Karlekar, Nancy L. Keating, June McKoy, Bruno C. Medeiros, Ewa Mrozek, Tracey O’Connor, Stephen H. Petersdorf, Hope S. Rugo, Rebecca A. Silliman, William P. Tew, Louise C. Walter, Alva B. Weir III, and Tanya Wildes

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Arti Hurria, Tanya Wildes, Sarah L. Blair, Ilene S. Browner, Harvey Jay Cohen, Mollie deShazo, Efrat Dotan, Barish H. Edil, Martine Extermann, Apar Kishor P. Ganti, Holly M. Holmes, Reshma Jagsi, Mohana B. Karlekar, Nancy L. Keating, Beatriz Korc-Grodzicki, June M. McKoy, Bruno C. Medeiros, Ewa Mrozek, Tracey O’Connor, Hope S. Rugo, Randall W. Rupper, Rebecca A. Silliman, Derek L. Stirewalt, William P. Tew, Louise C. Walter, Alva B. Weir III, Mary Anne Bergman, and Hema Sundar

Cancer is the leading cause of death in older adults aged 60 to 79 years. The biology of certain cancers and responsiveness to therapy changes with the patient’s age. Advanced age alone should not preclude the use of effective treatment that could improve quality of life or extend meaningful survival. The challenge of managing older patients with cancer is to assess whether the expected benefits of treatment are superior to the risk in a population with decreased life expectancy and decreased tolerance to stress. These guidelines provide an approach to decision-making in older cancer patients based on comprehensive geriatric assessment and also include diseasespecific issues related to age in the management of some cancer types in older adults.