*August 2024*
Lung cancer is generally viewed as an older person’s disease, with an average age at diagnosis of 70 in the U.S. But what happens when a disease that is tied to a more “vintage” population crops up in younger people? In a review in the ASCO Educational Book, Laura Mezquita, MD, PhD, of the Hospital Clinic of Barcelona in Spain, and colleagues noted that “young-onset lung cancer remains underexplored, lacking comprehensive data on its complex nature, with emerging evidence revealing age-related differences that affect outcomes and prognosis.”
Hopefully, though, data from the YOUNG LUNG Study will change those circumstances. Launched in 2023, the trial will look at the biology of the disease in those less than 45. The study is currently recruiting and has an estimated completion date of August 2027.
In the meantime, Mezguita’s group pointed out that younger patients with lung cancer have critical needs, such as career and life goals, not to mention the higher chance for physical and emotional stress from, say, worrying about fertility issues.
In their review, the authors highlighted the “complexities of lung cancer in young adults,” including:
- Given the multitude of lung cancer risk factors or carcinogens — tobacco smoke, other environmental factors, and occupational exposures — “it is important to conduct a comprehensive medical history that includes information on lifestyle habits, occupational or environmental exposures, if any, as well as personal and family history of cancer. This allows for a holistic understanding of the disease-risk factor context, which can contribute to better knowledge of the lung cancer and management,” the team wrote.
- Cancer onset at an early age should be a red flag for a possible genetic disorder. “Genetic predisposition plays a role in a subset of patients, with an estimated 5%-10% of all cancers associated with inherited alterations in cancer predisposition genes. However, there are no criteria for referring young and/or high-risk patients for genetic testing,” although clinicians can follow guidance from the National Comprehensive Cancer Network for genetic counseling and germline testing for non-small cell lung cancer (NSCLC), the authors said.
- Oncofertility should be part of the care continuum, when appropriate, and a discussion on the risks of treatment-induced gonadotoxicity in lung cancer “should follow the same approach as for women and men with other tumor types,” which can include ovarian tissue cryopreservation and sperm cryopreservation.
- “A grave diagnosis at a young age can alter a patient’s mindset, plunging their identity from someone in the summer of life to someone facing questions of mortality — questions unlikely to have been considered before diagnosis,” Mezquita and co-authors emphasized. They pointed out that because younger patients are more likely to find information about lung cancer online and to seek support via social media, providers should “remain vigilant in meeting patients where they are online, which could mean additional social media platforms in the future.” Read more.
