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Lung Cancer in Elderly Patients: An Analysis of the Surveillance, Epidemiology, and End Results Database

Taofeek K. Owonikoko, Camille C. Ragin, Chandra P. Belani, Ana B. Oton, William E. Gooding, Emanuela Taioli, Suresh S. Ramalingam

From the Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh; the Department of Epidemiology Graduate School of Public Health and the Division of Cancer Prevention and Population Science, University of Pittsburgh Cancer Institute; the Department of Biostatistics, University of Pittsburgh and University of Pittsburgh Cancer Institute, Pittsburgh, PA

Address reprint requests to Suresh Ramalingam, MD, Emory Winship Cancer Institute, 1365 Clifton Rd, Ste C-5090, Atlanta, GA 30322; e-mail: suresh.ramalingam{at}emory.edu

Purpose To study the burden and outcome of lung cancer in the elderly, particularly for patients aged 80 years and older.

Patients and Methods The national Surveillance, Epidemiology, and End Results database was analyzed for lung cancer outcomes during the period 1988 to 2003. A comparison was carried out between patients with lung cancer 80 years and older, 70 to 79 years, and younger than 70 years for demographics; stage distribution; 5-year relative survival; and survival based on histology, sex, race, stage, and treatment. The temporal trends in survival during the years 1988 to 1997 and 1998 to 2003 were also analyzed.

Results Of 316,682 patients eligible for the analysis, 45,912 (14%) were 80 years or older (ie, very elderly); 103,963 (33%) were 70 to 79 years; and 166,807 (53%) were younger than 70 years. The distribution by stage and histology was comparable for all the three groups. Overall survival rate at 5 years was lower in the very elderly (7.4% v 12.3% v 15.5%; P < .0001) across sex, histologic subtypes, stages, and racial categories. Patients aged 80 years or older were less likely to receive local therapy (no surgery or radiation) than younger patients (47% v 28% and 19% for the age subgroups 80 years, 70 to 79 years, and < 70 years, respectively). Overall outcomes for patients who underwent surgical therapy or radiation were comparable across the three age groups. In general, survival outcomes for the subgroup aged 70 to 79 years were similar to those of the subgroup aged 80 years and older who received single modality local therapy.

Conclusion Patients 80 years or older account for 14% (70 years or older accounted for 47%) of all lung cancers, are less likely to be subjected to surgery or radiation, and have inferior outcomes when compared with younger patients.

Supported by the Clinical Research Career Development Award by the ASCO Foundation (S.S.R.).

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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