Treatment Disparities in Elderly Patients With Non-Small Cell Lung Cancer

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Being African American and living in a lower-education area were associated with not receiving cancer-directed care.
Being African American and living in a lower-education area were associated with not receiving cancer-directed care.

According to a study published in Cancer, more than 62% of octogenarians and nonagenarians with stage III non-small cell lung cancer (NSCLC) do not receive cancer-directed care despite evidence that standard care concurrent chemotherapy plus radiotherapy (CRT) improves overall survival (OS).1

Although NSCLC is one of the most commonly diagnosed forms of cancer, its management among patients aged 80 years or older has remained largely unstudied.

For this study, investigators accessed the National Cancer Data Base (NCDB) to evaluate the treatment and outcomes of 12,641 elderly patients with newly diagnosed advanced NSCLC. Three treatment groups were identified: patients who received no treatment, patients who received definitive radiation only, and patients who received CRT. Various patient demographics including age, sex, race, comorbidities, insurance status, education, residence, income, and disease characteristics were assessed.

More than one-quarter (28.2%; 3567) of patients received CRT compared with 62.7% (7921) of patients who did not receive any therapy. Worse OS outcomes were observed among patients who received no treatment (hazard ratio [HR], 2.69; 95% CI, 2.57-2.82) or radiation only (HR, 1.15; 95% CI, 1.07-1.24) compared with patients who received CRT. Propensity score matching for all baseline variables showed that not receiving CRT was associated with worse OS outcomes (HR, 1.58; 95% CI, 1.44-1.72).

Two-year OS estimates were 31% (95% CI, 29.4%-32.5%) in the CRT arm, 23.6% (95% CI, 21.1%-26.1%) in the radiation-only arm, and 6.9% (95% CI, 6.3%-7.5%) in the no treatment arm (P <.01).

Living in a lower-education area (odds ratio [OR], 1.20; 95% CI, 1.03-1.40) and being African American (OR, 1.23; 95% CI, 1.06-1.43) were associated with not receiving any cancer-directed care.  

Reference

Cassidy RJ, Zhang X, Switchenko JM, et al. Health care disparities among octogenarians and nonagenarians with stage III lung cancer [published online January 8, 2018]. Cancer. doi:10.1002/cncr.31077

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