Caring for older adults with lung cancer is a complex challenge, but it's one we can meet with the right approach. The SIOG 2025 Roundtable Discussion, "Perspectives on Complexities in Treatment Selection for Older Adults with Lung Cancer," brought together experts to tackle this very issue. Chaired by Fabio Gomes, this discussion highlighted the critical need for a more nuanced approach to treatment.
A Case Study Unveils the Realities
The roundtable used a real-life case to illustrate the complexities. The patient, an older adult newly diagnosed with lung cancer, presented a range of challenges. These included diagnostic uncertainties, the presence of other health conditions (comorbidities), limitations in daily function, and conflicting priorities. All of these factors heavily influence treatment decisions, going far beyond what standard guidelines might suggest. The discussion started with the initial symptoms, diagnostic findings, and the first steps in managing the patient's condition.
But here's where it gets controversial...
Different Perspectives, Different Approaches
Under the guidance of Prof. Lore Decoster, the panel explored the case from both pulmonology and geriatric oncology perspectives. This highlighted how imaging choices, decisions about biopsies, and risk assessments can vary depending on the specialist's viewpoint. It also revealed how important details, such as the patient's functional abilities and mental well-being (psychosocial factors), can be overlooked when geriatric expertise isn't part of the team's discussions.
The Impact of Toxicity and Treatment Interruptions
The patient's treatment journey became a crucial turning point. Systemic therapy was started without a geriatric assessment, and the patient soon experienced significant side effects (toxicity), disrupting the treatment plan. This led to a broader discussion about what could have been anticipated: signs of frailty, concerns about multiple medications (polypharmacy), cognitive issues, or a decline in physical function that are often missed in routine oncology evaluations. Panelists noted that many complications are predictable and sometimes preventable when geriatric principles guide the decision-making process.
Why Geriatric Assessment Makes a Difference
The session then focused on practical solutions. Siri Rostoft and Theodora Karnakis explained how geriatric assessments can be easily integrated into lung cancer care. Even short screening tools can identify vulnerabilities that affect how medications are dosed, the intensity of treatment, and the need for supportive care. They emphasized that a geriatric assessment is more than just an extra step; it's a safety measure that leads to more personalized and realistic treatment plans.
Insights from Around the World
Attendees from various regions shared their experiences, describing cases where the absence of a geriatric assessment led to overly aggressive treatments, avoidable side effects, or missed opportunities for supportive care. The discussion emphasized the shared global challenge of treating older adults with lung cancer, who often face a combination of medical, functional, and social issues.
Bridging the Gap: The Path Forward
In his concluding remarks, Fabio Gomes reiterated the main takeaway: improving outcomes for older adults with lung cancer requires a coordinated, multidisciplinary approach that incorporates geriatric principles. Diagnostics, treatment planning, and managing side effects must consider the whole patient, not just the tumor. Integrating geriatric assessments, establishing structured care pathways, and recognizing when a more cautious approach is safer are essential steps toward better care.
And this is the part most people miss...
This roundtable made it clear that while complexity is inevitable, thoughtful collaboration among different specialties can transform the treatment experience for older adults with lung cancer.
What do you think? Do you agree that a multidisciplinary approach is essential for treating older adults with lung cancer? Have you seen the benefits of geriatric assessment in practice? Share your thoughts and experiences in the comments below!**
