Over Half of Octogenarians, Nonagenarians With NSCLC Do Not Receive Treatment

Lung cancer is the most common cause of cancer death in the United States, with over 158,000 people dying from the disease each year. While the standard-of-care therapy for patients with stage III non—small-cell lung cancer (NSCLC) is chemotherapy and radiotherapy (CRT), there are treatment disparities among octogenarians and nonagenarians, according to a study published in CANCER.

According to the authors of the study, there is a lack of clarity on the management of elderly patients with the disease: “To our knowledge, there is a lack of data regarding the use of CRT in octogenarians and nonagenarians, despite the fact that >36% of new lung cancers are diagnosed in patients >75 years,” wrote the authors. “These elderly patients may be undertreated and routinely are underrepresented on clinical trials.”

Using the National Cancer Data Base, the authors identified patients aged 80 and older who were diagnosed with stage III NSCLC from 2004 to 2014 with complete treatment records. Characteristics such as age, sex, race, comorbidities, and insurance status were documented. Tumor characteristics as well as treatment characteristics were also identified.

The statistical analysis was conducted using SAS statistical software and SAS macros. Multivariable logistic regression and Cox proportional hazard models were generated, and propensity score-matched analysis was used.

The cohort included 12,641 patients. The median age at time of diagnosis was 83 (range, 80-91 years), with a median follow-up of 28.6 months (2.1-140.7 months). Of the patients, 62.7% (7921) received no therapy. Those more likely to not receive therapy were those who were older, nonwhite, receiving treatment in the Western region of the US, females, living in a lower educated census tract, having adenocarcinoma histology, and having stage IIIB disease.

Of the patients, 28.2% (3567) received CRT. Those who were nonwhite and had a stage IIIB disease were more likely to not receive CRT. In the multivariable analysis, those who were older, black, living in a lower educated county, and having stage IIIB disease were associated with not receiving CRT.

Two-year overall survival (OS) estimates were 31% in the CRT cohort compared to 23.6% in the cohort treated with radiation alone and 6.9% in the cohort that received no treatment. Among patients who survived at least 6 months from their diagnosis, 2-year OS estimates were 32% for those who received CRT compared to 24.4% for those treated with radiation alone and 17.7% for those who received no treatment.

The univariable analysis showed that, among patients who did not receive treatment or received radiation alone, older age, male sex, having nonadenocarcinoma histology, and having stage IIIB disease were associated with worse OS. The same was shown in the multivariable anaylsis.

“Alarmingly, greater than one-half of octogenarians and nonagenarians with stage III lung cancer did not receive any care. Older age, black race, and living in a lower educated census tract were found to be risk factors for not receiving treatment,” wrote the authors. They concluded, “Further efforts to limit health care disparities in these elderly patients needs to be investigated.”