Association of Pretreatment Physical and Geriatric Parameters with Treatment Tolerance and Survival in Elderly Patients with Stage I–II Non-Small Cell Lung Cancer: An Evaluation of Usual Care Data

SIMPLE SUMMARY: Non-small cell lung cancer is predominantly a disease of older people in whom treatment intolerance is common. To make well-informed shared decisions concerning treatment options, pretreatment screening and/or assessment might be useful to identify patients who are expected to benefit from preventive lifestyle interventions. These interventions aim to improve a patient’s physical fitness before and during cancer treatment, resulting in improved treatment tolerance and a reduction of posttreatment complications. In this study, different physical and geriatric parameters were associated with treatment intolerance and survival in patients ≥70 years with stage I–II NSCLC undergoing surgery or stereotactic ablative radiotherapy. Evaluation of pretreatment physical and geriatric performance seems highly recommended for shared decision-making and selection of patients who might benefit from preventive interventions before and/or during treatment. ABSTRACT: In this study, the association of pretreatment physical and geriatric parameters with treatment tolerance and survival in elderly patients with stage I–II NSCLC was evaluated. Retrospective data for patients aged ≥70 years, diagnosed between 2016 and 2020 with stage I–II NSCLC, and who underwent surgery or stereotactic ablative radiotherapy (SABR) in a large Dutch teaching hospital were retrieved from medical records. Associations of pretreatment physical and geriatric parameters with treatment tolerance and survival were analyzed. Of 160 patients, 49 of 104 (47%) patients who underwent surgery and 21 of 56 (38%) patients who received SABR did not tolerate treatment. In univariable analysis, World Health Organization (WHO) performance status ≥ 2, short nutritional assessment questionnaire score > 1, short physical performance battery score ≤ 9, and geriatric-8 score ≤ 14 were significantly associated with postoperative complications. Forced expiratory volume of one second < 80% of predicted was significantly associated with intolerance of SABR. In multivariable analysis, WHO performance status ≥ 2 and diffusing capacity for carbon monoxide < 80% were significantly associated with decreased overall survival. This is the first study that investigated the association between pretreatment physical and geriatric parameters and treatment outcomes in patients with stage I–II NSCLC. Evaluation of physical and geriatric parameters before treatment initiation seems highly recommended to select patients who might benefit from preventive interventions before and/or during treatment.