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Older Adults Living Well With Lung Cancer

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Published on September 3, 2021

Living With Lung Cancer as an Older Adult

The average age of a person diagnosed with lung cancer is 70. In this video, Patient Power co-founder Andrew Schorr is joined by Carolyn Presley, MD, Assistant Professor and Director of the Oncogeriatrics Program at The James Cancer Hospital, Ohio State University, to discuss quality of life and treatment options for older adults with lung cancer. They also discuss why it is important to consider a clinical trial, the reasons to add a palliative care specialist to your medical team, and the resources that are available to improve quality of life. Visit the Cancer and Aging Research Group for more information.

Support for this series has been provided by Janssen Oncology. Patient Power maintains complete editorial control and is solely responsible for program content.

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Transcript | Older Adults Living Well With Lung Cancer

Andrew Schorr:
Hello, and welcome to Patient Power. I'm Andrew Schorr, today at the UC San Diego Cancer Center, where I'm a patient. But we're going to go clear across the country to Columbus, Ohio. And we have with us Dr. Carolyn Presley, who is a geriatric oncologist and specializes in lung cancer. And you're at Ohio State in the James Cancer Center there. Did I get it all right, Dr. Presley?

Dr. Presley:
That's correct. Thank you so much for having me. I'm delighted to be here today.

Andrew Schorr:
Thank you. Well, what I want to talk about is lung cancer in older patients. So first of all, cancer is more common in older people, as we get older, and that's true of lung cancer. I know there are younger people with lung cancer, but it certainly is common, unfortunately, in older people as well, right?

What Is the Average Age of Lung Cancer Diagnosis?

Dr. Presley:
That's correct. Lung cancer really is a disease of older adults. The average age of diagnosis is 70 years. And I've seen patients as young as in their teens, but as old as 100 years or older. But the average age is 70, and the majority are 60 years and older. And really, octogenarians, or patients in their 80s, are the fastest growing demographic. Not only in the United States, but also globally. And so, we are going to see more and more older adults, specifically octogenarians, with lung cancer over the next 30 years.

Andrew Schorr:
Wow. Okay. And you are board certified in geriatrics too. So, thank you for your focus on this. Let's talk about that. So first of all, when you're older, you may have other conditions as well. You may have diabetes, heart issues, arthritis, lots of things. So there at Ohio State, you've actually been bringing teams together to look at the whole patient. And also at the same time, where you have medicines to help people with lung cancer live longer.

Dr. Presley:
That's correct. When I came to the Ohio State University, I joined Dr. Ashley Roscoe. And we, along with a whole group of people, expanded and created the Cancer and Aging Resiliency Clinic, or CARE Clinic. And this is a consult clinic that sees any older adults, either with a blood cancer or a solid tumor, or patients who are going to be undergoing a bone marrow transplant. And there's a team of us. It's a longer visit, but that patient and their caregiver, who's invited to come as well, they see a case manager, a nutritionist, a pharmacist, and a nurse. We do memory testing. They see a physical therapist and an audiologist as well.

We also recently now have social work in addition to all those other disciplines. And they see the physician too. So, we really do a 360 evaluation of everything that we could potentially improve upon. And we give those recommendations to the treating oncologist, whether it's a hematologist or an oncologist, to really maximize quality of life, in addition to improving their overall survival.

Because we know that if you're able to provide recommendations to decrease treatment toxicity or side effects from the cancer treatment itself, that person will potentially live longer, if we're aggressively managing both symptoms and other comorbidities. And things that commonly start happening with age, that we feel like they're more common, but it's not necessarily normal. And these are things like falls, or delirium, or dementia. And these are comorbidities or geriatric conditions that we actually have a lot that we can do to help patients so that they might actually feel better and live longer, even though they have a new cancer diagnosis and are undergoing now cancer treatment in addition to everything else that was going on.

Andrew Schorr:
Wow. Well, Dr. Presley, first of all, a great credit to you and your colleagues there at Ohio State for bringing that together. And I hope that's a model. And I think our message to our viewers, wherever you are, if you're not an Ohio State patient or in that region, ask about that where you are. How can I be looked at as a whole person? I'm 70, I'm 80, I'm 90, maybe even 100, and have other stuff going on, and I want to live well.

Now let's talk about lung cancer and living longer. So, you have a much broader range of treatments than we had years ago to help people. And some with lower toxicity than the broad chemo people used to be blasted with. So, you must be excited about that, but the name of the game is not just living longer, but living well, right?

How Can Doctors Ensure High Quality of Life for Older Adults With Lung Cancer?

Dr. Presley:
That's right. And we've had more approvals for newer lung cancer treatments, I'd say in the last five years, than we have in the last 30 years. And really, immunotherapy and precision medicine, targeting a specific drug, a pill even, that you can take by mouth, has really revolutionized the treatment of lung cancer. The difficulty that we're running into is that the clinical trials that led to the approval of a lot of these medications, were younger and healthier than the patient populations that were using the medications in now that they have FDA approval.

So a lot of the research that I do, along with a lot of collaborators in the cancer and aging research group, are trying to determine, are the side effects the same or different in the real-world population compared to who was studied in the clinical trials? But you're right. If you're going to have a diagnosis of lung cancer, we have more now than we ever did before. And people are living longer than ever before. And just because you're older, doesn't mean that you shouldn't be offered treatment. And I want to say that again because it's so important. Just because you're older, you should be offered or at least have a conversation with a medical oncologist about treatment options, if that's within your goals.

And what we know over time, is that there is a lot of ageism that does occur, and that some older adults might not even be referred. And a referral doesn't mean that you're automatically going to get treatment right away. It's just having the conversation and whether or not that's aligned with your health goals. And the other thing I would say is to ask... If you see a medical oncologist, I would really advocate that patients get molecular testing done and PD-L1 testing done before they start treatment. Because the tendency is to start treatment as fast as possible, but it might not be the right treatment. And that can expose older adults in particular to additional side effects than if you wait for those testing results and start the right treatment as the first treatment. And cost can be a major factor in that decision, but many cancer centers and cancer programs have a team that can help improve the affordability of these medications.

Andrew Schorr:
Wow. Dr. Presley, you made some excellent points that we make on Patient Power regularly. Now, in lung cancer, first diagnostically, you need to know what subtype of lung cancer you're dealing with before you go off in this direction or that direction. And then also, where you said over so many years there's been this ageism, where an older patient who may have some other conditions, the doctor kind of gives them a pat on the head and said, we're going to give you palliative care. And let's just let the lung cancer take its course. So, you're saying it's the right of the patient to see someone like you to see what are your options. And then as you said, if there are financial issues, there are teams that can help assess that.

Dr. Presley:
Yes.

Andrew Schorr:
So get the care you need and deserve.

What Treatment and Palliative Care Options Are Available to Patients?

Dr. Presley:
And just at least get the information. And then you can make an informed decision. And the problem that we're seeing now, particularly with COVID, is that we're seeing a lot of cases that could have been caught earlier. So, if you're having concerning symptoms, you should see your medical provider. And even with COVID, it's important to get diagnosed and to at least hear about your treatment options.

And a lot of the research we do actually incorporates palliative care early on, but at the same time as their cancer treatment. And I emphasize that because patients who have aggressive symptom management by a symptom management expert, which is what palliative care is, actually do live longer, spend less time in the emergency department than if we don't do aggressive symptom management. And that's really their expertise. So again, at The James, we are really fortunate. We have a palliative care physician who is part of our team. She sits right next to me in clinic at least two days a week. We're hoping to expand that with grant funding that we're applying for to five days a week. So, all of our patients have that same access.

But what we're finding is that after we embedded a palliative care physician in our clinic, we're seeing a very substantial decrease in emergency department visits. And they're getting their cancer treatment, but they're also getting their symptoms, like shortness of breath or pain, aggressively managed. So that they're able to enjoy their life and live better and not be spending it in places like the emergency department, primarily for uncontrolled symptoms.

Andrew Schorr:
Wow. Well, that's terrific. And so, I think the message to our viewers today, if you or a loved one, older, is diagnosed with lung cancer, it can be a terrifying diagnosis. First, there's been great improvement in treatments, but also in symptom management. And so, it's not just about living longer, but it's about living as well as you can. Did I get it right?

Dr. Presley:
Correct. That's right. And so, if you have access to palliative care services, it doesn't mean that it's going to be focused on death and dying. They are focused on aggressive symptom management. The problem is, is that like geriatricians, there aren't enough to go around. And so, if you have access to that, or if you're having symptoms, to tell your doctor. Whether it's your oncologist, your hematologist, or even a lot of primary care physicians are also very good at symptom management. But having them involved doesn't mean that you're on death's doorstep. It just means that you could perhaps benefit from aggressive symptom management at the same time as your cancer treatment.

Andrew Schorr:
Okay. Well, we call our program Patient Power. And so, whether it's you, the patient, or an adult child who's advocating for you, your best friend, your next-door neighbor, you need to speak up about this. Because A, there's hope, and B, there's help.

Dr. Presley:
Yes.

Andrew Schorr:
Dr. Carolyn Presley, thank you so much for being with us from The James at Ohio State. And thank you for your leadership in helping older people like me, get the care they need and deserve. Thank you for being with us.

Dr. Presley:
Thank you.

Andrew Schorr:
I'm Andrew Schorr. Remember, knowledge and that “Patient Power” in advocating for yourself, taking advantage of what's available now – that can be the best medicine of all.

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