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The aim of this study was to observe the symptom improvement and clinical benefit in elderly patients with advanced non-small cell lung cancer (NSCLC) stratified on the basis of CGA findings after treatment with a combination of traditional Chinese medicine and Western medicine. Twenty-four elderly advanced NSCLC patients with a mean age of 73.0 ± 5.3 (65-83) years were categorized into three stratifications according to CGA results, namely function independent, mildly function impaired, and function dependent. They received standardized therapy, individualized therapy, and best supportive care, respectively. The patients receiving standardized therapy and individualized therapy were randomized into two groups, with or without traditional Chinese medicine for symptom control, while for all the patients receiving best supportive care, traditional Chinese medicine was administered. Nine non-elderly NSCLC patients (<65 years old) were enrolled as control and treated in accordance with NCCN NSCLC treatment guidelines. EORTC QLQ-C30 core scale, LC13 scale, and MDASI-TCM scale were used to assess relevant symptoms before and after treatment. After treatment for 3 weeks, it was shown by QLQ-C30+LC13 scales, for function-dependent patients, that the physical and role performances and the global health status were improved and the symptoms of fatigue and cough were alleviated; by MDASI-TCM scale, the symptoms of fatigue, cough, and expectoration were improved. In function-independent and mildly function-impaired elderly patients, there were no significant changes in functional status and symptoms. But in non-elderly patients, the physical and social performances were lowered, and the symptoms of fatigue, constipation, and poor appetite were aggravated. The elderly patients with advanced NSCLC were categorized on the basis of CGA findings, and traditional Chinese medicine may be beneficial to symptom control of function-dependent patients. [ABSTRACT FROM AUTHOR]

Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67 %) had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, and 79 (84 %) had non-small-cell lung cancer. In total, 28 patients (30 %) were newly diagnosed or were receiving first-line treatment, and 22 (23 %) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90 %), and ICU mortality and hospital mortality were 57 and 78 %, respectively. According to a multivariate analysis, a PaO/FiO ratio <150 [odds ratio (OR) = 5.51, 95 % confidence interval (CI) 2.10-14.48, p = 0.001] was independently associated with ICU mortality, and an ECOG PS ≥2 (OR = 9.53, 95 % CI 2.03-44.85, p = 0.004) and a need for vasoactive agents (OR = 6.94, 95 % CI 1.61-29.84, p = 0.009) were independently associated with hospital mortality. Refractory or bedridden patients ( n = 22) showed significantly poorer overall survival (11.0 vs. 29.0 days, p = 0.005). Among 21 patients who were discharged from the hospital, 11 (52 %) received further chemotherapy. Certain advanced lung cancer patients may benefit from ICU management. However, refractory patients and patients with a poor PS do not seem to benefit from ICU care. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care. [ABSTRACT FROM AUTHOR]