Management of elderly lung cancer patients in France: A national prospective survey by the French Intergroup of thoracic Oncology (IFCT)

Abstract

8163 Background. Thirty percent of lung cancer patients (pts) are 70 or older at diagnosis. However their representation in clinical trials is by far below and their management mostly unknown.We present here a survey about the management and determinants of survival of elderly lung cancer pts in France. Methods. Age categories (AC)(70–74, 75–80, 81–84, 85 and older), sex, social status, smoking habits, performance status (PS), comorbidities, histology, stage and treatment were studied. Results. From sept 02 to oct 03, 1540 pts were included by 77 centers. Data are available for 1000 pts. Median age was 76 (70–96). 810 were males (81%). 77% of males were married, 14% widowed (respectively 40% and 46.3% of females, p<.0001), these figures being similar to the general population statistics. 94.8% of the pts lived at home, the % decreasing from 98% to 87.1% with AC (p=.004). PS was 0 or 1 in 54.4%, >=2 in 44.8%. There was a trend towards a better PS in females (p = .056) and a significantly worst with increased AC. Histology was in 40.5% squamous cell, 15.5% small cell, 29% adenocarcinoma, 11.6% large cell. 52.6% of pts had a history of COPD, 37% hypertension, 18.6% ischaemic heart disease, 17.6 lower limb arteritis, 14.2% diabetes, 7.7% stroke. 857 were smokers or ex-smokers. There were more non-smokers in females (48% versus 2.7%, p<.0001). Also the % of non-smokers increased with AC from 6.4% to 40%. Bronchoscopy was performed in 96% of pts with positive biopsies in 60%. TTNA was performed in 20% of pts and positive in 18%. Imaging procedures were abdominal US in 60%, adrenal CT scan in 87%, brain CT in 79.5%, bone scan in 41%. 43.7% of NSCLC pts were metastatic and 72.3% SCLC pts. Treatment was only symptomatic in 16% with increasing frequency across the AC. Surgical resection was performed in 20%, mediastinal irradiation in 20.5% and chemotherapy in 70.7%. At 3-month follow-up available for 880 pts, 271 had died. Conclusions. Diagnostic procedures in elderly do not differ from that of younger pts. The % of symptomatic treatment only is higher and increasing with AC. Early death is not an infrequent feature probably rather explained by comorbidities than by PS. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration National Committee Against Respiratory Diseases; Bristol-Myers Squibb