Survival and functional outcomes in octogenarians with lung cancer.

Abstract

e20099 Background: The incidence of lung cancer is increasing among octogenarians, yet this population is less likely to receive guideline-concordant cancer-directed therapy. In addition to a higher comborbidity load and reduced physiologic reserve to tolerate treatment, many octogenarians may prioritize quality of life and avoidance of treatment burden over potential survival benefit. Consequently, a better understanding of survival and functional outcomes associated with cancer-directed therapy among octogenarians is needed to inform shared, goal-concordant decision-making. Methods: We conducted a retrospective cohort study using the TriNetX Research Network. Patients diagnosed with lung cancer at age 80 and older were identified and stratified by receipt of cancer-directed therapy (surgery, chemotherapy, immunotherapy, radiation, and/or tyrosine kinase inhibitor therapy) versus no treatment. Patients diagnosed prior to age 80 or without at least one follow-up visit were excluded. Baseline demographics and comorbidities were assessed. To reduce confounding, cohorts were balanced using 1:1 greedy nearest-neighbor propensity score matching based on demographics and comorbidities, with adequate balance defined as a standardized mean difference < 0.1. Post-matching outcomes included new oxygen requirements, utilization of physical or occupational therapy or home health services, and all-cause mortality. Results: After 1:1 propensity score matching, 27,012 patients aged ≥ 80 years with lung cancer were identified. 13,506 elected to receive some form of treatment and 13,506 remained untreated. Within 1 year of diagnosis, treated patients had higher odds of developing a new oxygen requirement compared with untreated patients (OR 1.33, 95% CI 1.19–1.50), but lower odds of physical/occupational therapy or home health utilization (OR 0.73, 95% CI 0.60–0.90). Treated patients also demonstrated lower short-term all-cause mortality (OR 0.79, 95% CI 0.75–0.84). Over longer follow-up (1 day to 5 years), treatment was associated with increased odds of new oxygen requirement (OR 1.38, 95% CI 1.25–1.52), no difference in functional support utilization (OR 0.99, 95% CI 0.84–1.18), and higher all-cause mortality (OR 1.08, 95% CI 1.03–1.13). Conclusions: Treatment in octogenarians with lung cancer improves short-term survival but increases pulmonary morbidity. Importantly, treatment was not associated with improved long-term survival, highlighting the need for individualized treatment decisions that carefully weigh potential short-term benefit against treatment-related morbidity in octogenarians.