One Diagnosis, Many Realities: Meeting the needs of today’s lung cancer patients

Why does age and frailty matter when it comes to lung cancer care?

With age and frailty comes added treatment complexity.

Managing lung cancer is already complex, however treating frail and elderly patients requires even more careful decision making, taking into account many additional aspects. 

“It’s not only about identifying the best treatment for a person’s tumour presentation, it’s also essential to factor in co-existing medical conditions, vital organ function, cognitive status and social circumstances,” explains Vince. “A frail patient might struggle with standard treatments. Ultimately, it’s about weighing all these elements up and striking the perfect balance to support an individual’s overall wellbeing.”

How can we effectively identify frail patients?

Practical, standard guidelines are key.

There are acknowledged benchmark metrics to define ‘frailty’. These commonly include an ECOG performance status score of 2 or more and presenting with major comorbidities.3 While tools like the Comprehensive Geriatric Assessment (CGA) are considered the gold standard, their application isn’t yet standardised across clinical practice.4 “We need to recognise patients who are frail, yet eligible for treatment,” says Vince. “Working with clinicians to roll out a practical way to identify frail patients, and embed this into routine care – across regions and clinics - can support the creation of tailored care plans.”

On an individual basis, sometimes it's as simple as asking: is this patient a suitable candidate for standard
chemotherapy-based treatment? If not, what alternatives might better serve their needs?”

What do we mean by tailored care plans?

Between 40 and 70% of lung cancer patients live with other illnesses and disorders, such as COPD or high blood pressure.5 This affects their diagnosis, treatment and prognosis. Each additional underlying condition influences the treatment options available and increases the risk of interactions between the medicines they are already taking, along with any additional lung cancer treatments. “These patients often have reduced physiological reserve, making the balance between treating the cancer and preserving overall health even more critical," says Vince.

How can we deliver patient-focused care?

Shared decision making is essential.

Survival. Quality of life. Maintaining independence. Preserving cognition. Minimising treatment burden. These are just some of the factors that frail and elderly people living with lung cancer will be weighing up when considering what matters most to them. 

“It makes sense to start with the individual’s goals and priorities and build a care plan from there,” says Vince. “Patient-focused care plans need to be built on an understanding of an individual’s lived reality, an openness to discuss personal wellbeing and a commitment to shared decision making from the outset.” 

Let’s take the burden of treatment as an example. “Flexible administration routes, such as subcutaneous formulations which are quick to administer, can help integrate treatment into daily routines," notes Vince. This is often particularly important for elderly or frail patients and their caregivers, who find the hospital visits for intravenous infusions physically, emotionally and logistically exhausting.6

What can be done to improve treatment options for frail and elderly lung cancer patients?

Knowledge is power.

“Generating robust evidence is essential for enabling informed treatment decisions,” Vince says. “This is why improving patient representation within clinical trials - including those who are elderly and frail - is so important and a focus of what we’re doing across our programmes at Roche. Addressing underrepresentation helps close the evidence gap for the very patients clinicians treat most often.”

What does the future hold for lung cancer treatment?

Vince’s take? “The opportunity to work with clinicians and the lung cancer community to support the treatment of every unique lung cancer patient – including the frail and elderly - is what drives us forward each day. Whether it’s building a stronger evidence base through our trials, innovating treatment options and solutions, or working with the community to think beyond traditional treatment protocols – I believe we can, and will, deliver tangible progress.”