If you’re 65 or older and newly diagnosed with non-small-cell lung cancer (NSCLC), you may wonder if your age will direct or potentially limit your treatment options and approach. Although age is a factor that oncologists take into account as they help guide you through treatment decisions, it’s only one piece of a larger picture.
As you get older, you’re more likely to have other health conditions, reduced kidney or heart function, lower muscle mass, and a harder time managing treatments that demand a lot of you physically. But the number of your years alone doesn’t tell your doctor you have these issues. They need a much broader picture of your health and your cancer to make decisions on your treatment.
“Age itself is not the main criteria,” says Grace Dy, MD, medical oncologist and director of Translational Research for Thoracic Medicine at Roswell Park Comprehensive Cancer Center. “It’s just that age is generally associated with lower organ function. And so, it’s organ function, along with overall fitness — including cognitive function — that drive our recommendations, along with personal preference as well.”
Bias against older people can also affect cancer care as you age. Studies show some older adults are undertreated because health care professionals assume they are too weak for certain therapies without looking into their personal health factors. But lung cancer treatments have changed drastically in recent years, and many people are living longer and well with lung cancer.
Learn more about which factors are most important in guiding your NSCLC care.
Age vs. Overall Health: What Really Matters With NSCLC
The first major factor oncologists consider when building a treatment plan for NSCLC is usually the stage of your cancer. This involves tests that tell them the size of the tumor and whether it is in the lung only or has spread to other places in your body. They assign your cancer a number (0-4), and this helps narrow down your treatment options to best match your cancer’s stage.
For example, if you have a very early stage (stage 0) disease, you may be able to treat it only with surgery. With later-stage cancer, your doctor will likely suggest a combination of treatments that may include radiation therapy, chemotherapy, immunotherapy, or targeted therapy.
Another key factor doctors look at is whether your cancer cells have mutations (changes) in certain genes, such as the epidermal growth factor receptor (EGFR) gene or the anaplastic lymphoma kinase (ALK) gene.
“For non-small-cell lung cancer, looking into the necessary markers can help us determine if there are non-chemotherapy options for treatment,” Dy says. “Because those may be better tolerated and may help reassure people who are older and leery about chemotherapy.”
After staging and genetic testing of your tumor, doctors look closely at your overall health. Your age plays a part in this, but Dy says it’s your biological age that is the key, not your chronological age.
“We don’t have a good test of biological age, but there are systems we can look at for clues,” Dy says.
Results from a clinical trial showed that a health measurement tool called a geriatric assessment can be an important part of treatment planning and can reduce side effects. A geriatric assessment looks at your:
- Kidney, liver, heart, and lung health
- Strength, mobility, and balance
- Weight loss and nutrition
- Other medical conditions
- Cognitive function
- Ability to manage daily activities independently
This kind of testing helps your doctor understand better how you might fare with certain treatments such as chemotherapy, which often involves more serious side effects than targeted therapies, for example.
“Somebody who’s in their 50s but not active and weak is a poor candidate for chemotherapy compared to somebody who’s in their 70s with minimal comorbidities, preserved organ function, and very physically active,” Dy says.
Where Age Does Influence Lung Cancer Treatment
Even when age alone isn’t driving treatment decisions, getting older can still affect how your body responds to therapies. You have less physical resilience and reserve as your systems get older, meaning treatment side effects can have a bigger impact on your independence and recovery.
“We cannot ignore that the older you are, the higher risk you are [at] for certain treatments, because we have to acknowledge that even in the most fit patients, there’s still some level of reduction in organ function,” Dy says.
That doesn’t mean you can’t have any kind of aggressive treatment, but it may mean you need:
- Closer monitoring
- Modified chemotherapy dosing
- More supportive care
- Greater attention to fall risk, hydration, and nutrition
- More discussion about trade-offs between benefits and side effects
Another factor to consider as you look at treatment options is that older adults have not always been included in cancer clinical trials as often as younger people, even though lung cancer is more common later in life.
That means researchers don’t always have as much information about how treatments affect you if you’re in your late 70s or 80s, especially if you also have other health conditions. Cancer experts are working to include more older adults in research and use more detailed health assessments so treatments can be better tailored to older people.
Dy encourages working to build strength, even if you didn’t focus on your fitness before your cancer diagnosis.
“It’s never too late to start maintaining muscle mass,” Dy says.
Physical activity such as walking and strength training can help reduce your fall risk, preserve balance, and improve your recovery times during treatment.
What Age Bias Can Look Like
Age bias can show up in cancer care in different ways. Your care team may not offer you some treatment options because of your age, or the team may avoid talking about clinical trials or more aggressive treatments because they assume you won’t want to take part.
Research shows older adults with NSCLC are sometimes less likely to get the standard treatments that doctors usually recommend, even when they are otherwise healthy enough to tolerate them. One of the reasons for that, Dy says, is because cancer treatment used to look very different decades ago.
“For the longest time, if you had advanced lung cancer, the only treatment option was chemotherapy, which is quite toxic,” Dy says. “And so, there can be this nihilistic sentiment about it.”
NSCLC treatment has advanced a lot since then. Even if your cancer doesn’t have a mutation with a targeted treatment, there are now newer chemotherapy combinations, immunotherapy, and supportive care, which are more tailored to you and can help you manage your cancer.
How to Think Through Treatment With Age as a Factor
When you’re weighing treatment options, it may help if you focus less on your age alone and more on what matters most to you. You can ask yourself certain questions that can help narrow down your preferences:
- What level of independence do I want to preserve?
- Which side effects concern me most?
- How important is living longer compared to maintaining day-to-day function?
- What activities or abilities are essential to my quality of life?
Knowing the answer to these questions can help you decide what’s best for your specific wants and needs. Some treatments may also worsen existing conditions such as heart disease, hearing loss, or nerve damage. So, if you are dealing with these issues, it will affect your decision.
For example, Dy says that a chemotherapy called cisplatin is one option for people with NSCLC, but it can affect hearing and nerves. For some people, those cons outweigh the pros.
“Some people say, ‘Well, I’m a musician,’ or ‘I do a lot of stuff with my hands,’ and choose different treatments because of how side effects could affect their daily lives,” Dy says.
These are decisions that can take a while to make, she says, so don’t feel rushed to choose in one visit. You may need more than one conversation and time to think through what works best for you. Your doctor will have valuable input in that conversation, too.
“We want to take into consideration what each person wants, but we also have to consider what is clinically, medically appropriate as well,” Dy says. “Someone may say, ‘Give me all you got,’ but their kidney function is poor, or they have heart failure. So, we have to think about how we balance ensuring quality of life is good while helping people live longer as well.”
