P2.16-32 Best Supportive Care for Extreme Elderly Lung Cancer Patients

Abstract

In Japan, the population of extreme elderly individuals (85 years and older) was about 5.8 million in 2018, and the number of extreme elderly lung cancer patients is increasing. Because of their environmental conditions, they often received the best supportive care (BSC) without chemotherapy or definitive therapy. We conducted an IRB-approved retrospective analysis of 34 lung cancer patients aged 85 years and older, who were treated at our institute from 2014 to 2017, and assessed their backgrounds and prognosis. The median age was 89 years (range, 85-96 years), and 22 patients were male. Among the patients considered, 11 had adenocarcinoma (3 harboring EGFR mutation), 8 had squamous cell carcinoma, 5 had NSCLC-NOS, 3 had SCLC, and 7 had an unknown cancer type. Fifteen patients were assigned an ECOG good PS of 0-2, and 19 patients a poor PS of 3-4. The main reasons for receiving BSC alone were poor PS (44%), own will (38%) and cognitive-function disorder (18%). In 10 patients, cancer did not metastasize and 15 patients were transferred to the nursing facility. The median overall survival was 5.6 months. According to univariate analysis (Cox proportional analysis), absence of metastatic disease [hazard ratio: 0.22, 95% confidence interval [C.I.]: 0.07-0.68], PS 0-2 [hazard ratio: 0.11, 95% C.I.: 0.04-0.34], good cognitive function [hazard ratio: 0.35, 95% C.I.: 0.14-0.89], good nutrition (serum albumin ≥3.5 g/dL) [hazard ratio: 0.09, 95% C.I.: 0.02-0.41] and plasma C reactive protein(CRP) ≤10 mg/L [hazard ratio: 0.27, 95% C.I.: 0.08-0.92] were associated with significantly longer overall survival. Median overall survival of patients with and without metastasis were 1.8 months and 19.7 months, respectively. Patients without metastasis tended to have good PS and had lesser hypoalbuminemia. Most of the patients without metastasis received BSC alone, of their own will. In extreme elderly lung cancer patients, BSC alone had often been selected for reasons other than the disease condition. It is important to construct a palliative treatment strategy based on medical and social characteristics of extreme elderly individuals.