Impact of being aged 80 years and older on treatment decision-making: Discrepancies in cancer care and associated outcomes.

Abstract

e13770 Background: Patients aged ≥80 years old (yo) account for ~14% of lung cancer (LC) diagnoses, yet are often underrepresented in clinical trials. We characterized the demographics, clinical features, treatment (tx) patterns, and outcomes of Veterans aged ≥80 with LC treated in a single-center VA cohort. Methods: Utilizing the VA Informatics and Computing Infrastructure (VINCI) database, we performed a retrospective study looking at patients ≥80 with a diagnosis of LC between 01 Jan 2014 and 01 Mar 2025 at a single VA medical center. Overall survival (OS) was estimated using the Kaplan–Meier (KM) method and differences were assessed using the log-rank test in R (Ver 4.5.1). Results: We included 184 patients (98.4% male), with a median age of 84. Race was 53.3% Black, 37.0% White, and 9.8% other/unknown. Most had a smoking history (94.4%). Histology was 81.0% non–small cell LC, 9.2% neuroendocrine carcinoma, and 9.8% unknown. Stage distribution was 47.8% I, 8.2% II, 9.3% III, 25.3% IV, and 9.4% unknown. Among stage I–II (n = 102), 61.8% underwent surgery (SG), 25.5% received non-surgical tx (radiation (RT)/chemotherapy (CT)/immunotherapy (IO)), and 12.6% received no tx. Among stage IV (n = 46), 34.8% received CT, 28.3% received other tx (RT/SG/IO), and 37.0% received no tx. Married patients were more likely to receive tx than unmarried (86.3% vs 64.7%). Palliative care consultation occurred in 19.2% of patients. NGS was performed in 24 patients, yielding 22 results; TP53 was most common (73%), followed by CDKN3A (13.6%) and KRAS (13.6%). Median and 5-year OS are illustrated in Table 1. Conclusions: In Veterans aged ≥80 years with LC, OS was strongly associated with functional status, stage, and tx intensity. These data suggest that advanced age alone should not preclude curative-intent management and support individualized, geriatric-informed tx selection for this population. n (%) a Median Age (IQR) (yo) Median OS (95% CI) (months) p-value 5-Year OS (95% CI) (%) p-value Race Black 98 (59.0) 84.0 (82.0 - 88.0) 48.2 (29.4 - 78.4) 0.85 46.0 (36.7 - 57.6) 0.79 White 68 (41.0) 84.0 (81.8 - 87.0) 49.2 (40.9 - 94.9) 44.2 (33.2 - 58.8) ECOG 0-1 52 (55.9) 84.0 (82.0 - 86.3) 61.3 (47.9 - 127.2) <0.001 57.1 (44.3 - 73.6) <0.001 ≥2 41 (44.1) 84.0 (82.0 - 88.0) 7.8 (4.8 - 27.6) 12.9 (5.7 - 29.1) Stage I-II 102 (62.2) 83.5 (81.0 - 86.0) 78.4 (60.3 - 102.0) <0.001 59.7 (50.3 - 71.0) <0.001 III-IV 62 (37.8) 85.0 (83.0 - 88.0) 6.6 (4.4 - 20.7) 18.4 (10.8 - 31.3) Treatment Local Only (SG, RT) 92 (68.1) 83.5 (81.0 - 86.0) 81.7 (54.2 - 110.5) 0.02 58.7 (48.8 - 70.5) 0.002 Systemic Only (CT, IO) 22 (16.3) 84.5 (83.0 - 86.8) 20.7 (15.3 - 70.6) 24.2 (11.3 - 51.8) Both local and systemic 21 (15.6) 83 (82.0 - 85.0) 85.5 (30.2 - n/a b ) 59.2 (40.7 - 86.2) a Analyses performed using available data. Patients with missing data/small subgroups excluded. Thus, totals may not sum up to the full cohort (n = 184). b Upper confidence limit not reached due to insufficient events.