- Email: [email protected]
Surgical resection of lung cancer in elderly patients
9th SIOG Meeting, October 16–18, 2008, Montreal, Canada: Saturday, October 18, 2008 cancer immunotherapy. Most cancer patients are elderly, but adaptive immunity wanes with age. One might therefore predict that immunosenescence would result in decreased immunosurveillance against cancer and decreased efficacy of cancer immunotherapy. However, there is also evidence that immune responses and especially inflammation can in fact enhance tumorigenesis and may in some cases even be a prerequisite for tumour development. The generally increased inflammatory status (innate immunity) and decreased T and possibly B cell responsiveness (adaptive immunity) in the elderly may thus conspire to enhance tumorigenesis and to decrease defences against cancer in older patients. There are several animal models in which cell-based immunotherapy against cancer is successful in young but not old individuals, consistent with these expectations. On the other hand, there are also some animal models in which the opposite is true, ie. immunotherapy is effective in the old but NOT the young. These findings are consistent with clinical experience that younger patients often have a worse clinical course than more indolent progression in seniors. We are therefore faced with a paradox. Possibly, the important thing is to maintain an appropriate balance between effective anti-tumour immunity and tumour escape and/or stimulatory mechanisms mediated by the different arms of the immune system. Tumours almost always coexist with immune defence systems over extended periods and interact chronically with T cells and other immune cells. The effect of this may be similar to other situations of chronic antigenic stress, particularly lifelong persistent virus infection, most commonly with Cytomegalovirus, where we now have extensive information regarding the impact of antigenic stress on immunity. Questions to be explored are what happens when T lymphocyte clones are chronically stimulated by antigen which is not eliminated? What are the similarities and differences between chronic antigenic stimulation by tumour antigen versus CMV or other non-self antigen? Can we learn from one system to illuminate facets of the other? Here, I will discuss in vitro models of chronic antigenic stress in human T cells and changes to immune parameters observed ex vivo in studies of the elderly and of cancer patients. The existence of an “immune risk profile” (IRP) predicting mortality in the elderly will be presented and the question raised as to whether the IRP may be informative also in cancer patients. Knowledge of factors contributing to increased risk of mortality is expected to facilitate the design of appropriate interventions to reduce that risk. 09.20–10.40
Session X B: Prostate, bladder and kidney cancer F26 09.20–10.40 Therapeutic approach of prostate cancer in the elderly patient F. Saad *. University of Montr´eal, Sherbrooke, Montr´eal, Qu´ebec, Canada Prostate cancer remains the most common cancer diagnosed in the western world and is the third leading cause of cancer mortality in men in North America. Screening and early diagnosis of prostate cancer has lead to a significant reduction in newly diagnosed metastatic cancers in North America but the true impact of screening on mortality and morbidity remains controversial because of the long natural history of a large proportion of untreated early stage prostate cancer. When considering treatment options in early stage prostate cancer the clinician is obliged to consider not only the stage and grade of the tumor but also the life expectancy of the patient. All treatment options must be considered in early stage prostate cancer in patients with long life expectancy. Options include radical prostatectomy, radiation therapy (external beam and/or brachytherapy) as well as watchful waiting (active surveillance with intervention according to progression). Since morbidity of the therapeutic options differ, one must also include quality of life priorities of the patient. In patients with limited life expectancy, watchful waiting should be strongly considered if the cancer does not appear to be aggressive or locally extensive. In more aggressive cases radiation therapy becomes an option to consider with or without the addition of androgen deprivation therapy (ADT). In the more advanced stages of prostate cancer therapeutic options diminish as well as cure rates. In the latter stages of the disease, or in the case of recurrence following local therapy, ADT plays a major role, either
S17
alone or in combination with other local therapies. In cases of metastatic prostate cancer ADT becomes the standard of care with attention to bone health through the use of bisphosphonate therapy to reduce the risk of debilitating bone complications that affect the vast majority of before they eventually succumb to the disease. When patients progress while on ADT they encounter the greatest degree of morbidity related to prostate cancer and life expectancy is quite short for the majority of patients. At this stage of the disease docetaxel based chemotherapy plays a central role in terms of attempting to prolong life as well as improve pain control and quality of life. The role of chemotherapy in earlier stages of the disease to reduce the risk of recurrence and prolong life in high risk patients is presently being studied in large phase 3 studies. F27 09.20–10.40 Androgen deprivation therapy in prostate cancer – an update on indications and toxicities S. Alibhai *. Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada Androgen deprivation therapy (ADT) has become a mainstay of therapy for prostate cancer. Although it was initially reserved for men with symptomatic metastatic disease, expanding indications over the past two decades have led to greater and earlier use. Current estimates suggest that almost 1 in 2 currently diagnosed men with prostate cancer will receive ADT at some point after diagnosis. Recent clinical trials and other studies have provided important evidence on the role of ADT as primary therapy for localized prostate cancer, on duration of ADT use as adjuvant therapy to radical radiotherapy in intermediate and high-risk disease, as well as providing the first studies examining the role of intermittent versus continuous ADT. Concurrently, there has been increasing evidence of important toxicities of chronic ADT use, including deleterious effects on bone, cardiovascular disease, cognition, and diabetes. While some of these risks are clear and consistently demonstrated, others remain much more controversial, such as the effect on myocardial infarction, sudden cardiac death, and cognitive function. This overview will summarize recently published and emerging evidence on indications for ADT in the non-metastatic setting. In particular, published evidence will be presented (a) confirming survival benefits of long-term ADT adjuvant to radiotherapy for men with high-risk disease; (b) demonstrating benefits of ADT adjuvant to radiotherapy in men with intermediate-risk disease; (c) on the optimal duration of ADT in men being treated adjuvantly (in particular, the inferiority of 6 months as compared to 24 months of ADT); (d) lack of survival benefit with primary ADT for localized prostate cancer; (e) preliminary trial data on efficacy of intermittent versus continuous ADT. With respect to toxicities of ADT, recent studies will be summarized demonstrating: (a) excess risk of fragility fractures and any fractures (with an absolute excess risk of 3−6% over 5 years); (b) inconsistent evidence with respect to cardiovascular disease (both acute myocardial infarction and sudden cardiac death), (c) increased risk of diabetes (with an absolute excess risk of 1% over 5 years); (d) inconsistent effects on cognitive function. 09.20–10.40
Session X C: Lung cancer F28 Surgical resection of lung cancer in elderly patients
09.20–10.40
M.T. Jaklitsch *. Brigham and Women’s Hospital, Boston, Massachusetts, USA Surgical resection of lung cancer in elderly patients must match the magnitude of surgery to the constitution of the elderly patient. Surgical literature advising general thoracic surgeons to resect locally advanced lung cancer seems disproportionate to clinical experience. For instance, the overwhelming majority of thoracic surgery literature advises that surgical resection can be performed irregardless of age. Yet, the intuitive sense of physicians caring for elderly patients is that they are denied standard
S18
Critical Reviews in Oncology/Hematology 68 (2008)
Abstracts
surgical procedures. Large databases such as the SEER database, support the generalized impression that surgical resection is not offered at the same rate as in younger populations. A prospective trial within the cooperative group of CALGB was used to stratify the thoracic surgery procedures as a function of age and risk group. Low, high, and very high risk groups were identified as a function of PFTs: Not surprisingly, the willingness to offer surgery to high risk and very high risk patients (as a function of pulmonary function) was related to the age of the patient. Summary of procedures stratified by age and risk group Procedure
Low risk
High risk
Very high risk
Total
pts <70 y, pts 70 y, pts <70 y, pts 70 y, pts <70 y, pts 70 y, n (%) n (%) n (%) n (%) n (%) n (%) N Pneumonectomy Lobectomy Sublobara Otherb a Segmental
151 35 (23%) 83 (55%) 22 (15%) 11 (7%)
76 9 (12%) 57 (75%) 8 (11%) 2 (3%)
37 5 (14%) 26 (70%) 5 (14%) 1 (3%)
14 1 (7%) 8 (57%) 5 (36%) 0
36 2 (6%) 12 (33%) 19 (53%) 3 (8%)
32 1 (3%) 16 (50%) 14 (44%) 1 (3%)
346 53 (15%) 202 (58%) 73 (21%) 18 (5%)
or “Less than lobe”. sleeve lobectomy, and thoracotomy.
Reference(s) [1] Kassam F, Shepherd FA, Johnston M, et al. Referral patterns of adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. J Thorac Oncol 2(1): 39−43, 2007. [2] Pepe C, Hasan B, Winton TL, et al. Adjuvant Vinorelbine and cisplatin in elderly patients: National Cancer Insitutte of Canada and Intergroup Study JBR.10. J Clin Oncol 25(12): 1553−61, 2007. [3] Wheatley-Price P, Ding K, Seymour L, Clark GM, Shepherd FA. Erlotinib for advanced non-small-cell lung cancer in the elderly: an analysis of the NCIC CTG Study BR.21. J Clin Oncol 26: 2350−7, 2008. [4] Ramalingam SS, Dahlberg SE, Langer CJ, et al. Outcomes for elderly advancedstage non-small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: Analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol 26: 60−65, 2008.
F30 Radiotherapy for the patient with lung cancer
b Bilobectomy,
F29 Treatment of lung cancer
All patients should be assessed for diagnostic investigation and treatment of their lung cancer, be it curative or palliative. With an increasing number of treatment options, oncologists may be able to better tailor treatment to the individual, minimizing toxicity while maximizing benefit.
09.20–10.40
N. Leighl *. Princess Margaret Hospital, Toronto, Ontario, Canada Lung cancer remains the leading cause of cancer-related mortality around the world. It commonly affects older individuals, with a median age at diagnosis of 69. Age plays a significant role in the diagnosis and management of lung cancer. When important prognostic factors are controlled for, advanced age does not predict for shortened survival in advanced non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). However older lung cancer patients are less likely to receive both potentially curative and palliative therapies. If left untreated, older patients with lung cancer have a median survival of only 6 to 18 months. Despite this, clinicians are less likely to diagnose, investigate and refer older patients for lung cancer treatment than younger patients. There are many potential reasons, including both patient and physician factors. Patients may be too frail, have too many comorbidities or advanced lung cancer symptoms, precluding further investigations and treatment. Physicians may be reluctant to refer patients for further investigation and treatment if they perceive that the patient’s prognosis is severely limited, or that potential treatments would carry substantial toxicity, especially in the palliative setting. Adjuvant platinum-based chemotherapy for patients with completely resected early stage NSCLC has become a new standard. However only two-thirds of patients are referred for adjuvant chemotherapy, and only half of those eligible go on to receive treatment. The most commonly cited reason not to be referred or receive therapy is patient refusal for reasons of age [1]. In a landmark Canadian trial of adjuvant chemotherapy, those older than 65 benefited to the same degree as younger patients, without excess toxicity or hospitalization [2]. However older patients were less likely to complete treatment, usually because of patient refusal. There have been several studies of systemic therapy in advanced disease, demonstrating that older patients do benefit from palliative chemotherapy, but are more likely to experience toxicity. This is also true of the newer targeted therapies in lung cancer. Erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI), has been shown to improve survival and quality of life after chemotherapy failure. In an analysis of patients 70 and older, there was no difference in terms of survival or quality of life benefit derived from erlotinib, but older patients were more likely to have severe toxicity, and to discontinue treatment [3]. Also in a recent subset analysis of patients 70 and older treated on a randomized trial of first-line chemotherapy plus or minus bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), older patients had a trend to higher response and progression-free survival but not overall survival with the addition of bevacizumab [4]. They were also more likely to have more toxicity, raising concerns about the widespread use of bevacizumab as a new standard in older adults. However there are many exciting novel treatments with less toxicity that may be of benefit in older patients in future.
09.20–10.40
J. Ayll´on *. Centre Int´egr´e de lutte contre le Cancer de la Mont´er´egie – Hˆopital Charles LeMoyne, Greenfield Park, Montr´eal, Qu´ebec, Canada Purpose: The objective of this presentation is to review the information available about the treatment of lung cancer in the elderly, obtained from different trials and analyses published recently. Methods: Different data sources available in the internet, institutional publications and web sites were reviewed. A PubMed data search was done and correlated with the results from phase II and phase III trials. At least 6 different trials related to the issue with significant information were found. Others were also taken into consideration and registered as additional data sources. Most of the trials included elderly patients with non-resectable locally advanced lung cancer. The review was mainly focused on nonsmall cell disease because of its incidence and frequency. The end point was to determine the benefits of aggressive combined chemoradiation for this population. Results: Most of the trials reviewed showed advantages from combined chemoradiation for locally advanced NSCLC in the elderly in terms of median survival and overall survival. Despite of an increased incidence of moderate or severe side effects, we can conclude that the combined modality is the best approach for the treatment of elderly patients with locally advanced non-resectable NSCLC. A cautious approach according to the performance status is suggested. Specific studies in elderly patients and ongoing trials will probably confirm these facts. 11.00–12.20
Session XI A: Making sense of and to the geriatric oncology patient F31 11.00–12.20 “I don’t know”: How to explain clinical trials data to the elderly patient S. Mohile *. University of Rochester Medical Center, Rochester, United Kingdom There is a great deal of uncertainty in predicting outcomes for older patients with cancer. Uncertainty in illness can occur when a person perceives that the illness and treatment is inconsistent or unpredictable. Uncertainty may be most particularly difficult during discussions of prognosis, during which patients often perceive statistics as more precise estimates than they actually are. Communication of uncertainly can be difficult for both the physician and the patient. Communication between physicians and their older cancer patients should help the patients receive bad news, understand and remember complex information, understand statistics related to prognosis, build trust that will sustain long-term clinical relationships, and make decisions about treatment, including potentially participation in clinical trials. To achieve patient-centered care, physicians can adopt behavioral and perceptual skills that promote communication.
Session X B: Prostate, bladder and kidney cancer F26 09.20–10.40 Therapeutic approach of prostate cancer in the elderly patient F. Saad *. University of Montr´eal, Sherbrooke, Montr´eal, Qu´ebec, Canada Prostate cancer remains the most common cancer diagnosed in the western world and is the third leading cause of cancer mortality in men in North America. Screening and early diagnosis of prostate cancer has lead to a significant reduction in newly diagnosed metastatic cancers in North America but the true impact of screening on mortality and morbidity remains controversial because of the long natural history of a large proportion of untreated early stage prostate cancer. When considering treatment options in early stage prostate cancer the clinician is obliged to consider not only the stage and grade of the tumor but also the life expectancy of the patient. All treatment options must be considered in early stage prostate cancer in patients with long life expectancy. Options include radical prostatectomy, radiation therapy (external beam and/or brachytherapy) as well as watchful waiting (active surveillance with intervention according to progression). Since morbidity of the therapeutic options differ, one must also include quality of life priorities of the patient. In patients with limited life expectancy, watchful waiting should be strongly considered if the cancer does not appear to be aggressive or locally extensive. In more aggressive cases radiation therapy becomes an option to consider with or without the addition of androgen deprivation therapy (ADT). In the more advanced stages of prostate cancer therapeutic options diminish as well as cure rates. In the latter stages of the disease, or in the case of recurrence following local therapy, ADT plays a major role, either
S17
alone or in combination with other local therapies. In cases of metastatic prostate cancer ADT becomes the standard of care with attention to bone health through the use of bisphosphonate therapy to reduce the risk of debilitating bone complications that affect the vast majority of before they eventually succumb to the disease. When patients progress while on ADT they encounter the greatest degree of morbidity related to prostate cancer and life expectancy is quite short for the majority of patients. At this stage of the disease docetaxel based chemotherapy plays a central role in terms of attempting to prolong life as well as improve pain control and quality of life. The role of chemotherapy in earlier stages of the disease to reduce the risk of recurrence and prolong life in high risk patients is presently being studied in large phase 3 studies. F27 09.20–10.40 Androgen deprivation therapy in prostate cancer – an update on indications and toxicities S. Alibhai *. Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada Androgen deprivation therapy (ADT) has become a mainstay of therapy for prostate cancer. Although it was initially reserved for men with symptomatic metastatic disease, expanding indications over the past two decades have led to greater and earlier use. Current estimates suggest that almost 1 in 2 currently diagnosed men with prostate cancer will receive ADT at some point after diagnosis. Recent clinical trials and other studies have provided important evidence on the role of ADT as primary therapy for localized prostate cancer, on duration of ADT use as adjuvant therapy to radical radiotherapy in intermediate and high-risk disease, as well as providing the first studies examining the role of intermittent versus continuous ADT. Concurrently, there has been increasing evidence of important toxicities of chronic ADT use, including deleterious effects on bone, cardiovascular disease, cognition, and diabetes. While some of these risks are clear and consistently demonstrated, others remain much more controversial, such as the effect on myocardial infarction, sudden cardiac death, and cognitive function. This overview will summarize recently published and emerging evidence on indications for ADT in the non-metastatic setting. In particular, published evidence will be presented (a) confirming survival benefits of long-term ADT adjuvant to radiotherapy for men with high-risk disease; (b) demonstrating benefits of ADT adjuvant to radiotherapy in men with intermediate-risk disease; (c) on the optimal duration of ADT in men being treated adjuvantly (in particular, the inferiority of 6 months as compared to 24 months of ADT); (d) lack of survival benefit with primary ADT for localized prostate cancer; (e) preliminary trial data on efficacy of intermittent versus continuous ADT. With respect to toxicities of ADT, recent studies will be summarized demonstrating: (a) excess risk of fragility fractures and any fractures (with an absolute excess risk of 3−6% over 5 years); (b) inconsistent evidence with respect to cardiovascular disease (both acute myocardial infarction and sudden cardiac death), (c) increased risk of diabetes (with an absolute excess risk of 1% over 5 years); (d) inconsistent effects on cognitive function. 09.20–10.40
Session X C: Lung cancer F28 Surgical resection of lung cancer in elderly patients
09.20–10.40
M.T. Jaklitsch *. Brigham and Women’s Hospital, Boston, Massachusetts, USA Surgical resection of lung cancer in elderly patients must match the magnitude of surgery to the constitution of the elderly patient. Surgical literature advising general thoracic surgeons to resect locally advanced lung cancer seems disproportionate to clinical experience. For instance, the overwhelming majority of thoracic surgery literature advises that surgical resection can be performed irregardless of age. Yet, the intuitive sense of physicians caring for elderly patients is that they are denied standard
S18
Critical Reviews in Oncology/Hematology 68 (2008)
Abstracts
surgical procedures. Large databases such as the SEER database, support the generalized impression that surgical resection is not offered at the same rate as in younger populations. A prospective trial within the cooperative group of CALGB was used to stratify the thoracic surgery procedures as a function of age and risk group. Low, high, and very high risk groups were identified as a function of PFTs: Not surprisingly, the willingness to offer surgery to high risk and very high risk patients (as a function of pulmonary function) was related to the age of the patient. Summary of procedures stratified by age and risk group Procedure
Low risk
High risk
Very high risk
Total
pts <70 y, pts 70 y, pts <70 y, pts 70 y, pts <70 y, pts 70 y, n (%) n (%) n (%) n (%) n (%) n (%) N Pneumonectomy Lobectomy Sublobara Otherb a Segmental
151 35 (23%) 83 (55%) 22 (15%) 11 (7%)
76 9 (12%) 57 (75%) 8 (11%) 2 (3%)
37 5 (14%) 26 (70%) 5 (14%) 1 (3%)
14 1 (7%) 8 (57%) 5 (36%) 0
36 2 (6%) 12 (33%) 19 (53%) 3 (8%)
32 1 (3%) 16 (50%) 14 (44%) 1 (3%)
346 53 (15%) 202 (58%) 73 (21%) 18 (5%)
or “Less than lobe”. sleeve lobectomy, and thoracotomy.
Reference(s) [1] Kassam F, Shepherd FA, Johnston M, et al. Referral patterns of adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. J Thorac Oncol 2(1): 39−43, 2007. [2] Pepe C, Hasan B, Winton TL, et al. Adjuvant Vinorelbine and cisplatin in elderly patients: National Cancer Insitutte of Canada and Intergroup Study JBR.10. J Clin Oncol 25(12): 1553−61, 2007. [3] Wheatley-Price P, Ding K, Seymour L, Clark GM, Shepherd FA. Erlotinib for advanced non-small-cell lung cancer in the elderly: an analysis of the NCIC CTG Study BR.21. J Clin Oncol 26: 2350−7, 2008. [4] Ramalingam SS, Dahlberg SE, Langer CJ, et al. Outcomes for elderly advancedstage non-small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: Analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol 26: 60−65, 2008.
F30 Radiotherapy for the patient with lung cancer
b Bilobectomy,
F29 Treatment of lung cancer
All patients should be assessed for diagnostic investigation and treatment of their lung cancer, be it curative or palliative. With an increasing number of treatment options, oncologists may be able to better tailor treatment to the individual, minimizing toxicity while maximizing benefit.
09.20–10.40
N. Leighl *. Princess Margaret Hospital, Toronto, Ontario, Canada Lung cancer remains the leading cause of cancer-related mortality around the world. It commonly affects older individuals, with a median age at diagnosis of 69. Age plays a significant role in the diagnosis and management of lung cancer. When important prognostic factors are controlled for, advanced age does not predict for shortened survival in advanced non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). However older lung cancer patients are less likely to receive both potentially curative and palliative therapies. If left untreated, older patients with lung cancer have a median survival of only 6 to 18 months. Despite this, clinicians are less likely to diagnose, investigate and refer older patients for lung cancer treatment than younger patients. There are many potential reasons, including both patient and physician factors. Patients may be too frail, have too many comorbidities or advanced lung cancer symptoms, precluding further investigations and treatment. Physicians may be reluctant to refer patients for further investigation and treatment if they perceive that the patient’s prognosis is severely limited, or that potential treatments would carry substantial toxicity, especially in the palliative setting. Adjuvant platinum-based chemotherapy for patients with completely resected early stage NSCLC has become a new standard. However only two-thirds of patients are referred for adjuvant chemotherapy, and only half of those eligible go on to receive treatment. The most commonly cited reason not to be referred or receive therapy is patient refusal for reasons of age [1]. In a landmark Canadian trial of adjuvant chemotherapy, those older than 65 benefited to the same degree as younger patients, without excess toxicity or hospitalization [2]. However older patients were less likely to complete treatment, usually because of patient refusal. There have been several studies of systemic therapy in advanced disease, demonstrating that older patients do benefit from palliative chemotherapy, but are more likely to experience toxicity. This is also true of the newer targeted therapies in lung cancer. Erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI), has been shown to improve survival and quality of life after chemotherapy failure. In an analysis of patients 70 and older, there was no difference in terms of survival or quality of life benefit derived from erlotinib, but older patients were more likely to have severe toxicity, and to discontinue treatment [3]. Also in a recent subset analysis of patients 70 and older treated on a randomized trial of first-line chemotherapy plus or minus bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), older patients had a trend to higher response and progression-free survival but not overall survival with the addition of bevacizumab [4]. They were also more likely to have more toxicity, raising concerns about the widespread use of bevacizumab as a new standard in older adults. However there are many exciting novel treatments with less toxicity that may be of benefit in older patients in future.
09.20–10.40
J. Ayll´on *. Centre Int´egr´e de lutte contre le Cancer de la Mont´er´egie – Hˆopital Charles LeMoyne, Greenfield Park, Montr´eal, Qu´ebec, Canada Purpose: The objective of this presentation is to review the information available about the treatment of lung cancer in the elderly, obtained from different trials and analyses published recently. Methods: Different data sources available in the internet, institutional publications and web sites were reviewed. A PubMed data search was done and correlated with the results from phase II and phase III trials. At least 6 different trials related to the issue with significant information were found. Others were also taken into consideration and registered as additional data sources. Most of the trials included elderly patients with non-resectable locally advanced lung cancer. The review was mainly focused on nonsmall cell disease because of its incidence and frequency. The end point was to determine the benefits of aggressive combined chemoradiation for this population. Results: Most of the trials reviewed showed advantages from combined chemoradiation for locally advanced NSCLC in the elderly in terms of median survival and overall survival. Despite of an increased incidence of moderate or severe side effects, we can conclude that the combined modality is the best approach for the treatment of elderly patients with locally advanced non-resectable NSCLC. A cautious approach according to the performance status is suggested. Specific studies in elderly patients and ongoing trials will probably confirm these facts. 11.00–12.20
Session XI A: Making sense of and to the geriatric oncology patient F31 11.00–12.20 “I don’t know”: How to explain clinical trials data to the elderly patient S. Mohile *. University of Rochester Medical Center, Rochester, United Kingdom There is a great deal of uncertainty in predicting outcomes for older patients with cancer. Uncertainty in illness can occur when a person perceives that the illness and treatment is inconsistent or unpredictable. Uncertainty may be most particularly difficult during discussions of prognosis, during which patients often perceive statistics as more precise estimates than they actually are. Communication of uncertainly can be difficult for both the physician and the patient. Communication between physicians and their older cancer patients should help the patients receive bad news, understand and remember complex information, understand statistics related to prognosis, build trust that will sustain long-term clinical relationships, and make decisions about treatment, including potentially participation in clinical trials. To achieve patient-centered care, physicians can adopt behavioral and perceptual skills that promote communication.