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Lung cancer in the very elderly: incidence, presentation, and diagnostic decision-making. A retrospective analysis at a teaching community hospital.

Ayyappan S, Gonzalez C, Yarlagadda R, Zakharia Y, Woodlock TJ - J Community Hosp Intern Med Perspect (2011)

Bottom Line: The number of very elderly lung cancer patients in this community setting has been significant and appears to be increasing.These patients were more likely to have an incomplete diagnostic work-up, with patient and family wishes being the major factor in medical decision-making.The physician approach to these patients emphasized patient autonomy and medical factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Unity Health System of Rochester, NY, USA.

ABSTRACT

Background and objectives: Lung cancer presentation and decision-making in the very elderly patient population, 80 years of age and older, was studied given the projected increase in cancer incidence in the very elderly and yet only limited management guidelines.

Design and setting: A 10-year experience at the Unity Health System of Rochester, NY, was reviewed using tumor registry data for the entire lung cancer population plus focused medical record review of very elderly patients. A questionnaire survey on the clinical approach to lung cancer in the elderly was distributed to medical staff involved in their care.

Participants measurements and results: Of 997 patients, approximately 100 cases each year, the very elderly comprised 18% of patients from year 1998 through 2002, and 23% from year 2003 through 2007. One-third of the very elderly were diagnosed with lung cancer on clinical grounds without tissue confirmation. The majority of this group had cardio-pulmonary symptoms and an advanced clinical stage. The very elderly had no tissue sampling as per their own decision in 12 of 44 of cases, per family decision in 28 of 44, and per physician and other input in 4 of 44. Physicians stated that patient wishes and health-related factors, more so than socio-economic factors, were primary concerns for management decision-making.

Conclusions: The number of very elderly lung cancer patients in this community setting has been significant and appears to be increasing. These patients were more likely to have an incomplete diagnostic work-up, with patient and family wishes being the major factor in medical decision-making. The physician approach to these patients emphasized patient autonomy and medical factors.

No MeSH data available.


Related in: MedlinePlus

Significant factors and challenges affecting the management of lung cancer in elderly patients: results from a physician provider survey.
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Figure 0002: Significant factors and challenges affecting the management of lung cancer in elderly patients: results from a physician provider survey.

Mentions: Following our review of the above findings, a voluntary confidential survey questionnaire on the physician approach to elderly patient with lung cancer was developed and distributed to our medical staff directly involved in their care. The questionnaire was returned by 34 of 103 primary care providers, 4 of 11 geriatricians, and 27 of 45 internal medicine resident trainees. Responses were similar among the provider groups and are summarized in Fig. 2. Among factors significantly affecting management, 100% of responders respected patient wishes and autonomy; 96% stressed patient quality of life; and 96% noted the importance of cancer histology, grade, and stage. In contrast, 62% of providers reported patient age per se as a concern and 46% reported socioeconomic status as a factor. Among known challenges to providing care to elderly lung cancer patients, 90% felt medical comorbidities were challenging, 84% were concerned about treatment toxicity risks, and 50% noted lack of patient social support as an issue.


Lung cancer in the very elderly: incidence, presentation, and diagnostic decision-making. A retrospective analysis at a teaching community hospital.

Ayyappan S, Gonzalez C, Yarlagadda R, Zakharia Y, Woodlock TJ - J Community Hosp Intern Med Perspect (2011)

Significant factors and challenges affecting the management of lung cancer in elderly patients: results from a physician provider survey.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3714041&req=5

Figure 0002: Significant factors and challenges affecting the management of lung cancer in elderly patients: results from a physician provider survey.
Mentions: Following our review of the above findings, a voluntary confidential survey questionnaire on the physician approach to elderly patient with lung cancer was developed and distributed to our medical staff directly involved in their care. The questionnaire was returned by 34 of 103 primary care providers, 4 of 11 geriatricians, and 27 of 45 internal medicine resident trainees. Responses were similar among the provider groups and are summarized in Fig. 2. Among factors significantly affecting management, 100% of responders respected patient wishes and autonomy; 96% stressed patient quality of life; and 96% noted the importance of cancer histology, grade, and stage. In contrast, 62% of providers reported patient age per se as a concern and 46% reported socioeconomic status as a factor. Among known challenges to providing care to elderly lung cancer patients, 90% felt medical comorbidities were challenging, 84% were concerned about treatment toxicity risks, and 50% noted lack of patient social support as an issue.

Bottom Line: The number of very elderly lung cancer patients in this community setting has been significant and appears to be increasing.These patients were more likely to have an incomplete diagnostic work-up, with patient and family wishes being the major factor in medical decision-making.The physician approach to these patients emphasized patient autonomy and medical factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Unity Health System of Rochester, NY, USA.

ABSTRACT

Background and objectives: Lung cancer presentation and decision-making in the very elderly patient population, 80 years of age and older, was studied given the projected increase in cancer incidence in the very elderly and yet only limited management guidelines.

Design and setting: A 10-year experience at the Unity Health System of Rochester, NY, was reviewed using tumor registry data for the entire lung cancer population plus focused medical record review of very elderly patients. A questionnaire survey on the clinical approach to lung cancer in the elderly was distributed to medical staff involved in their care.

Participants measurements and results: Of 997 patients, approximately 100 cases each year, the very elderly comprised 18% of patients from year 1998 through 2002, and 23% from year 2003 through 2007. One-third of the very elderly were diagnosed with lung cancer on clinical grounds without tissue confirmation. The majority of this group had cardio-pulmonary symptoms and an advanced clinical stage. The very elderly had no tissue sampling as per their own decision in 12 of 44 of cases, per family decision in 28 of 44, and per physician and other input in 4 of 44. Physicians stated that patient wishes and health-related factors, more so than socio-economic factors, were primary concerns for management decision-making.

Conclusions: The number of very elderly lung cancer patients in this community setting has been significant and appears to be increasing. These patients were more likely to have an incomplete diagnostic work-up, with patient and family wishes being the major factor in medical decision-making. The physician approach to these patients emphasized patient autonomy and medical factors.

No MeSH data available.


Related in: MedlinePlus