Skip to main content

Advertisement

SpringerLink
Log in

Lung Cancer in the Oldest Old: A Nation-Wide Study in The Netherlands

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Introduction

An important step in improving research and care for the oldest patients with lung cancer is analyzing current data regarding diagnostic work-up, treatment choices, and survival.

Methods

We analyzed data on lung cancer from the Netherlands Cancer Registry (NCR–IKNL) regarding diagnostic work-up, treatment, and survival in different age categories; the oldest old (≥85 years of age) versus those aged 71–84 (elderly) and those aged ≤70 years (younger patients).

Results

47,951 patients were included in the 2010–2014 NCR database. 2196 (5%) patients were aged ≥85 years. Histological diagnosis was obtained significantly less often in the oldest old (38%, p < 0.001), and less standard treatment regimen was given (8%, p < 0.001) compared to elderly and younger patients. 67% of the oldest old received best supportive care only versus 38% of the elderly and 20% of the younger patients (p < 0.001). For the oldest old receiving standard treatment, survival rates were similar in comparison with the elderly patients. In the oldest old, no survival differences were found when comparing standard or adjusted regimens for stage I and IV NSCLC; for stage III, oldest old receiving standard treatment had longer survival. No oldest old patients with stage II received standard treatment.

Conclusion

Clinicians make limited use of diagnostics and invasive treatment in the oldest old; however, selected oldest old patients experienced similar survival rates as the elderly when receiving some form of anticancer therapy (standard or adjusted). More research is needed to further develop individualized treatment algorithms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

NSCLC:

Non-small cell lung cancer

SCLC:

Small cell lung cancer

IKNL:

Integraal Kankercentrum Nederland

NCR:

Netherlands Cancer Registry

References

  1. IKNL. Longkanker (2016). www.cijfersoverkanker.nl

  2. Horner MJRL, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, E. B. (eds) (2009) No title. SEER cancer statistics review, 1975-2006, National Cancer Institute. Bethesda, MD, Bethesda, MD: National Cancer Institute; 2009. based on November 2008 SEER data submission, posted to the SEER web site, 2009 http://seer.cancer.gov/csr/1975_2008/results_merge

  3. Inouye SK, Peduzzi PN, Robison JT et al (1998) Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 279:1187–1193

    Article  CAS  PubMed  Google Scholar 

  4. Balducci L (2000) Geriatric oncology: challenge for the new century. Eur J Cancer 36:1741–1754

    Article  CAS  PubMed  Google Scholar 

  5. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55:241–252

    Article  PubMed  Google Scholar 

  6. Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncol 5:224–237

    Article  CAS  Google Scholar 

  7. Schulkes KJG, Nguyen C, van den Bos F, van Elden LJR, Hamaker ME (2016) Selection of patients in ongoing clinical trials on lung cancer. Lung. doi:10.1007/s00408-016-9943-7

    Google Scholar 

  8. Mol L, Koopman M, van Gils C, Ottevanger P, Punt C (2013) Comparison of treatment outcome in metastatic colorectal cancer patients included in a clinical trial versus daily practice in The Netherlands. Acta Oncol 52:950–955

    Article  PubMed  Google Scholar 

  9. Lamb BW et al (2013) Facilitators and barriers to teamworking and patient centeredness in multidisciplinary cancer teams: findings of a national study. Ann Surg Oncol 20:1408–1416

    Article  CAS  PubMed  Google Scholar 

  10. Lamb BW et al (2011) Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg 35:1970–1976

    Article  PubMed  Google Scholar 

  11. Sacco PC et al (2015) Current challenges of lung cancer care in an aging population. Expert Rev Anticancer Ther 15:1419–1429

    Article  CAS  PubMed  Google Scholar 

  12. NVALT. Kleincellig longcarcinoom (2016). www.oncoline.nl

  13. NVALT. Niet-kleincellig longcarcinoom (2016). www.oncoline.nl

  14. Driessen EJM et al (2016) Stage III Non-Small Cell Lung Cancer in the elderly: patient characteristics predictive for tolerance and survival of chemoradiation in daily clinical practice. Radiother Oncol 121:26–31

    Article  PubMed  Google Scholar 

  15. Janssen-Heijnen MLG, Maas HAAM, van de Schans SAM, Coebergh JWW, Groen HJM (2011) Chemotherapy in elderly small-cell lung cancer patients: yes we can, but should we do it? Ann Oncol 22:821–826

    Article  CAS  PubMed  Google Scholar 

  16. Janssen-Heijnen MLG et al (2012) Treatment and survival of patients with small-cell lung cancer: small steps forward, but not for patients >80. Ann Oncol 23:954–960

    Article  CAS  PubMed  Google Scholar 

  17. Dawe DE, Pond GR, Ellis PM (2016) Assessment of referral and chemotherapy treatment patterns for elderly patients with non-small-cell lung cancer. Clin Lung Cancer 17:563–572.e2

    Article  PubMed  Google Scholar 

  18. Koyi H et al (2016) Non-small cell lung cancer (NSCLC) in octogenarians in clinical practice. Anticancer Res 36:5397–5402

    Article  PubMed  Google Scholar 

  19. Satoh H et al (2009) Lung cancer in patients aged 80 years and over. Lung Cancer 65:112–118

    Article  PubMed  Google Scholar 

  20. Kurishima K et al (2001) Lung cancer in the octogenarian. Gerontology 47:158–160

    Article  CAS  PubMed  Google Scholar 

  21. Oxnard GR, Fidias P, Muzikansky A, Sequist LV (2007) Non-small cell lung cancer in octogenarians: treatment practices and preferences. J Thorac Oncol 2:1029–1035

    Article  PubMed  Google Scholar 

  22. Collis E, Sleeman KE (2013) Do patients need to know they are terminally ill? Yes. BMJ 346:f2589

    Article  PubMed  Google Scholar 

  23. Blackhall LJ (2013) Do patients need to know they are terminally ill? No. BMJ 346:f2560

    Article  PubMed  Google Scholar 

  24. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A 56:M146–M156

    Article  CAS  Google Scholar 

  25. Schulkes KJG, Hamaker ME, van den Bos F, van Elden LJR (2016) Relevance of a geriatric assessment for elderly patients with lung cancer-a systematic REVIEW. Clin Lung Cancer. doi:10.1016/j.cllc.2016.05.007

    PubMed  Google Scholar 

  26. Janssen-Heijnen MLG et al (2014) Tolerance and benefits of treatment for elderly patients with limited small-cell lung cancer. J Geriatr Oncol 5:71–77

    Article  PubMed  Google Scholar 

  27. Janssen-Heijnen MLG et al (2004) Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer. Thorax 59:602–607

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Corre R et al (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol 34:1476–1483

    Article  CAS  PubMed  Google Scholar 

  29. Yellen GB, Cella DF, Leslie W (1994) Age and clinical decision making in oncology patients. J Natl Cancer Inst 86:1766–1770

    Article  CAS  PubMed  Google Scholar 

  30. Choulliara Z, Miller M, Stott D et al (2004) Older people with cancer: perceptions and feelings about information, decision-making and treatment - a pilot study. Eur J Oncol Nurs 8:257–261

    Article  Google Scholar 

  31. Hamaker ME et al (2016) Evaluation and reporting of quality of life outcomes in phase III chemotherapy trials for poor prognosis malignancies. Qual Life Res. doi:10.1007/s11136-016-1360-0

    PubMed  Google Scholar 

  32. Schulkes KJG, Nguyen C, van den Bos F, Hamaker ME, van Elden LJR (2016) Patient-centered outcome measures in lung cancer trials. Lung. doi:10.1007/s00408-016-9903-2

    Google Scholar 

  33. Goodare H, Smith R (1995) The rights of patients in research. Br Med J 310:1277–1278

    Article  CAS  Google Scholar 

  34. Speight J, Barendse SM (2010) FDA guidance on patient reported outcomes. Br Med J 340:2921

    Article  Google Scholar 

  35. Spilker B (1995) Quality of life and clinical trials. Lancet 346:1–2

    Google Scholar 

  36. US Department of Health and Human Services Food, and Drug Administration (2006) Guidance for industry: patient report outcome measures: use in clinical medical product development to support labelling claims: draft guidance. Heal Qual Life Outcomes 4:79

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice.

Financial Support

This study was supported by the Aart Huisman Scholarship for research in geriatric oncology and the Cornelis Visser Foundation.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands

    Karlijn J. G. Schulkes, Carin A. M. Pouw & Marije E. Hamaker

  2. Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands

    Elisabeth J. M. Driessen & Maryska L. G. Janssen-Heijnen

  3. Department of Pulmonology, Diakonessenhuis, Utrecht, The Netherlands

    Leontine J. R. van Elden

  4. Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands

    Frederiek van den Bos

  5. Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands

    Maryska L. G. Janssen-Heijnen

  6. Department of Pulmonology, UMC Utrecht, Utrecht, The Netherlands

    Jan-Willem J. Lammers

Authors
  1. Karlijn J. G. Schulkes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carin A. M. Pouw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabeth J. M. Driessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leontine J. R. van Elden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frederiek van den Bos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maryska L. G. Janssen-Heijnen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan-Willem J. Lammers
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marije E. Hamaker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karlijn J. G. Schulkes.

Ethics declarations

Conflict of interest

No potential conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Appendix

Appendix

See Table 2.

Table 2 Summary of Dutch lung cancer guideline-recommended treatment
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schulkes, K.J.G., Pouw, C.A.M., Driessen, E.J.M. et al. Lung Cancer in the Oldest Old: A Nation-Wide Study in The Netherlands. Lung 195, 627–634 (2017). https://doi.org/10.1007/s00408-017-0026-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-017-0026-1

Keywords

Search

Navigation