Management of lung cancer in older adults

Introduction Lung cancer is the leading cause of cancer-related deaths in the world, with more than a million deaths reported each year. In the United States, approximately 215,000 new cases of lung cancer were diagnosed in the year 2008. Elderly patients (aged 70 years or more) account for about 50 percent of all lung cancers in the United States. Notably, 14 percent of the patients are 80 years of age or older. Because the population older than 65 years constitutes the fastest-growing segment of the United States, the number of cases of lung cancer diagnosed in elderly patients is expected to increase in the near future. Lung cancer presents at an advanced stage in a majority of the patients. Systemic therapy constitutes the mainstay of treatment for advanced-stage disease and is associated with modest survival and quality-of-life benefits. Earlier stages of lung cancer are treated with combined modality treatment that consists of either surgery or radiation with systemic therapy. Though important therapeutic advances have been accomplished in a number of areas of lung cancer, including the development of molecularly targeted agents, the overall 5-year survival rate remains dismal at less than 15 percent. Non-small-cell lung cancer (NSCLC) accounts for approximately 85 percent of all cases of lung cancer. It includes the histological subtypes adenocarcinoma, squamous cell carcinoma, large-cell carcinoma, and bronchioalveolar carcinoma (BAC). Small-cell lung cancer (SCLC), which is the other major histological type, has decreased in incidence in recent years.