Association of Pretreatment Physical and Geriatric Parameters with Treatment Tolerance and Survival in Elderly Patients with Stage I–II Non-Small Cell Lung Cancer: An Evaluation of Usual Care Data

Abstract

In this study, the association of pretreatment physical and geriatric parameters with treatment tolerance and survival in elderly patients with stage I–II NSCLC was evaluated. Retrospective data for patients aged ≥ 70 years, diagnosed between 2016 and 2020 with stage I–II NSCLC, and who underwent surgery or stereotactic ablative radiotherapy (SABR) in a large Dutch teaching hospital were retrieved from medical records. Associations of pretreatment physical and geriatric parameters with treatment tolerance and survival were analyzed. Of 160 patients, 49 of 104 (47%) patients who underwent surgery and 21 of 56 (38%) patients who received SABR did not tolerate treatment. In univariable analysis, World Health Organization (WHO) performance status ≥ 2, short nutritional assessment questionnaire score >1, short physical performance battery score ≤ 9, and geriatric-8 score ≤ 14 were significantly associated with postoperative complications. Forced expiratory volume of one second < 80% of predicted was significantly associated with intolerance of SABR. In multivariable analysis, WHO performance status ≥ 2 and diffusing capacity for carbon monoxide < 80% were significantly associated with decreased overall survival. This is the first study that investigated the association between pretreatment physical and geriatric parameters and treatment outcomes in patients with stage I–II NSCLC. Evaluation of physical and geriatric parameters before treatment initiation seems highly recommended to select patients who might benefit from preventive interventions before and/or during treatment.

Preoperative Physical Dysfunction Characteristics and Influence Factors Among Elderly Patients with Early Lung Cancer: A Latent Class Analysis

“…Voorn et al found that preoperative physical parameters in elderly lung cancer patients were associated with treatment tolerance and survival, and they recommended comprehensive physical and geriatric parameters before surgery, as well as active interventions to improve the physical status of elderly lung cancer patients prior to surgery, in order to better adapt to the surgery. 28 The preoperative pulmonary functional status can have a substantial impact on the patient's prognosis and postoperative quality of life. 29 Preoperative pulmonary function training can enhance pulmonary ventilation and reduce pulmonary complications.…”

“…37 Furthermore, in elderly patients with early lung cancer, preoperative physical function parameters are linked to treatment tolerance and survival rates, and low preoperative physical function scores are linked to a higher likelihood of unfavorable treatment outcomes. 28 It is therefore recommended that older patients review their physical function before treatment, as well as chronic illnesses, and so on, in order to make a shared decision and option. Additionally, patients may benefit from preventive intervention during therapy.…”