In the Journals Plus

Most older patients with advanced lung cancer receive no therapy

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January 8, 2018

Richard Cassidy

A majority of patients with stage III lung cancer aged older than 80 years received no cancer-directed therapy, according to study results published in Cancer.

Further, black race and residence in a lower-educated census tract increased likelihood of not receiving care.

“We highlight risks for patients not receiving standard therapy and show that patients who receive standard care live longer,” Richard Cassidy, MD, radiation oncologist at Winship Cancer Institute of Emory University, said in a press release. “Our study also highlights health care disparities in the oncology community and showcases a need for the oncology community to address. This may provide information to guide outreach programs to engage the elderly community in seeking appropriate therapy for stage III lung cancer.”

Guidelines for the management of stage III lung cancer among elderly patients state that only select, fit patients should receive sequential or concurrent chemoradiation. However, the guidelines also state that options “should be considered with caution” due to the limited data for this population.

Due to the increasing number of patients with cancer aged older than 80 years, Cassidy and colleagues used the National Cancer Data Base to identify patient and tumor factors associated with receiving and not receiving chemoradiotherapy among octogenarians and nonagenarians, as well as to determine how treatment impacted OS.

The analysis included 12,641 patients (median age at diagnosis, 83 years; range, 80-91), 6,018 (47.6%) of whom had stage IIIA disease and 6,621 (52.4%) of whom had stage IIIB disease.

Median follow-up was 28.6 months (range, 2.1-140.7).

A majority of patients (n = 7,921; 62.7%) received no therapy.

On multivariable analysis, patients who were black (OR = 1.23; 95% CI, 1.06-1.43) and who lived in a lower-educated census tract (OR = 1.2; 95% CI, 1.03-1.4) had increased likelihood of not receiving care, whereas lack of treatment appeared less common among patients treated at an academic center (OR = 0.8; 95% CI, 0.7-0.92).

Tumor characteristics associated with lack of care included poorly differentiated histologic grade (OR = 1.28; 95% CI, 1.01-1.62) and stage IIIB disease (OR = 2.11; 95% CI, 1.95-2.28).

Compared with chemoradiotherapy, no treatment (HR = 2.69; 95% CI, 2.57-2.82) or receiving definitive radiotherapy alone (HR = 1.58; 95% CI, 1.44-1.72) increased mortality risk.

Not receiving chemoradiotherapy also increased risk for poor OS in a propensity score-matched analysis (HR = 1.58; 95% CI, 1.44-1.72). Two-year OS rates reached 33.4% in the chemoradiotherapy treatment cohort, compared with 25.2% in the matched untreated cohort (P < .01).

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“The higher rate of receipt of no therapy in the current study is especially concerning because all patients in our series had health insurance, which has been known to impact clinical outcomes,” the researchers wrote. “Despite an insured population, socioeconomic barriers still appeared to influence the receipt of care, with black patients found to be 23% more likely and patients living in a lower educated census tract found to be 20% more likely to not receive cancer-directed therapy, which also has been shown to affect general mortality rates in geriatric adults.”

Strategies to limit health care disparities in this population are needed, the researchers added. – by Alexandra Todak

 

Disclosures: The authors report no relevant financial disclosures.