Elderly Patients With Advanced Lung Cancer In Elderly Comprehensive Evaluation, The Clinical Research Of Tcm Intervention And Survival Benefit

Purpose:According to results of CGA (comprehensive geriatric assessment), advanced lung cancer patients are grouped into different stratifications and treated with combination of traditional Chinese and Western medicine, and symptom improvement and survival benefit will be observed.Method:Based on ADL (activities of daily life), IADL (instrumental activities of daily life) and nutrition status, older advanced lung cancer patients were grouped into3different stratifications, including functional independence, intermediate functional impairment and functional dependence, according to assessment results, by reference of NCCN senior adult oncology guideline, respectively giving standardized treatment, individualized treatment and palliative care treatment. The patients receiving standardized therapy and individualized therapy were randomized into2groups, with or without traditional Chinese medicine for symptom control, while for palliative care patients, traditional Chinese medicine for symptom control was administered. EORTC QLQ C30core scale, LCl3lung cancer scale and MDASI-TCM scales were used to observe relevant symptoms before and after treatment. IL-2, noradrenaline and P16INK4α levels in peripheral blood were tested.Results:A total of24elderly advanced lung cancer patients with an average age of73.0±5.3(65-83) years were included, with CGA assessment, functional independence10cases, intermediate functional impairment6cases, and functional dependence8cases, for the same time period,9non-elderly lung cancer patients (<65years old) were included for contrast, and received treatment recommended in accordance with the NCCN non-small cell lung cancer treatment guidelines. For QLQ C30+LC13scales, before treatment, function and overall health subscale between functional independence and intermediate functional impairment patients did not differ significantly in elderly patients. For functional dependence patients, physical functioning, social functioning and overall health status declined in the scale, and there were significant differences (P<0.05) compared with functional independence and intermediate functional impairment patients. According to symptoms subscale, in the elderly patients, the symptoms of fatigue, shortness of breath, and coughing were significant. After treatment, for functional independence and intermediate functional impairment patients, functional subscale score changes are not obvious, but in functional dependence patients, body functioning, role functioning, and general health subscale improved than before treatment, and there is significant difference (P<0.05). For symptoms subscale, the symptom score of functional independence and intermediate functional impairment elderly patients does not change significantly. Due to a limited number of cases, no statistical contrast between with or without traditional Chinese medicine symptom control groups of functional independence and intermediate functional impairment stratifications was performed. In function dependent patients, the score of symptoms of fatigue and coughing was lower, indicating improvement of the symptoms. Non-elderly patients scored higher in fatigue, constipation and loss of appetite, indicating the above symptoms were worse. For MDASI-TCM scale, before treatment, in all patients, the highest-scoring symptoms were fatigue, cough, expectoration, sweating, and irritability. Among the three stratifications in the elderly patients, the factor impeding life mostly was the emotional status, and there were no significant differences in elderly patients among different functional statuses. Non-elderly patients had a worse emotional status than the elderly patients. After treatment, in all elderly patients, the highest-scoring symptoms were fatigue, shortness of breath, sweating, irritability, and poor appetite. For function dependent patients, fatigue, cough and expectoration were improved, and due to a limited number of cases, no statistical contrast between with or without traditional Chinese medicine symptom control groups of functional independence and intermediate functional impairment stratifications was performed. Non-elderly patients with fatigue, disturbed sleep, poor appetite, constipation and other symptoms scored much higher. IL-2, noradrenaline and P16INK4α levels in peripheral blood were different.Conclusion:Based on the results of CGA including functionality and nutritional status, advanced elderly lung cancer patients were grouped into different stratifications including functional independence, intermediate functional impairment, and functional dependence, which is different from traditional PS rating results. Symptomatic control treatment with traditional Chinese medicine can improve the symptoms of function dependent patients, such as fatigue and cough. But for functional independence and intermediate functional impairment patients with advanced lung cancer, clinical benefit needs further research.