Elizabeth David, MD, FACS
Researchers at the UC Davis Comprehensive Cancer Center evaluated data from the National Cancer Database over the period from 1998 to 2012 and found 21% of patients with non–small cell lung cancer (NSCLC) had not received chemotherapy, radiotherapy, or surgery. Additionally, many of these individuals were women, elderly, minorities, of low income, or uninsured.
The pattern is especially relevant to patients with late-stage disease. During the study period, the number of untreated patients with stage IIIA and stage IV NSCLC increased, and the overall survival (OS) rates of untreated patients compared with those receiving standard therapies were significantly lower.
“A large number of untreated patients were statistically similar to patients who received standard therapies,” according to study author Elizabeth David, MD, FACS. Thus, she raised the question: If patients had similar demographic and clinical characteristics, could more of the untreated patients benefit from treatment?
“While it’s not realistic to expect every patient to get treatment, we may be too easily deciding not to treat,” said David, assistant professor of surgery at UC Davis Medical Center, in a statement.
The median survival for patients with stage IIIA NSCLC who received chemotherapy and radiation is 16.5 months. For those who received no treatment, the median OS was 6.1 months. Patients with stage IV NSCLC who had received chemotherapy had a median OS of 9.3 months, whereas those without treatment had a median OS of 2 months.
The researchers cautioned that they cannot discern the motivations of the patients or physicians from this dataset, and there are a number of factors that could play a role in the decision, including race, age, insurance status, or referral patterns.
They recommended future studies examining the impact of access to care. David also mentioned the existence of stigma for patients with lung cancer. “I think that influences both patients and providers. Efforts to lessen the stigma are ongoing, including educational and social media initiatives highlighting the fact that the number of lung cancer cases in people who have never smoked cigarettes continues to rise.”
Patients should at least be made aware of the options for treatment and the risks and benefits that come with each, David noted.
“My hope is that this study will raise awareness among physicians and encourage them to reconsider fundamental decisions, such as whether patients may be candidates for treatments or not,” David said. “I’m hoping providers consider these data timely and significant. Not getting treated for this cancer is associated with dismal outcomes. Although more progress is needed, meaningful treatment options do exist, and they are easier to tolerate than they used to be.”
David EA, Daly ME, Li CS, et al. Increasing rates of no treatment in advanced-stage non-small cell lung cancer patients: a propensity-matched analysis [published online before print January 18, 2017]. J Thorac Oncol.