Almost Half of Older Adults With Metastatic NSCLC Went Untreated

Researchers in the United States conducted a population-based study using SEER-Medicare data to investigate the treatment of older adults with metastatic non-small cell lung cancer (mNSCLC). The study revealed that despite significant advancements in therapies over the past two decades, nearly half of the participants never received systemic treatment.

The study included 254,611 patients aged 65 years and older who were diagnosed with mNSCLC between 2006 and 2021. Investigators examined treatment rates, factors linked to receiving treatment and trends over time as newer therapies such as immunotherapy and targeted therapies became more widely available.

Researchers reported that 46.8% of patients received at least one systemic treatment, while 53.2% did not receive treatment. The proportion of patients receiving treatment increased only slightly over time, rising from 44.8% in 2006 to a peak of 51.6% in 2019 before declining somewhat during the COVID-19 pandemic years.

The study authors concluded that, despite treatment advances, many older patients with mNSCLC still are not receiving systemic therapy, including some patients who may have been considered good candidates for treatment.

Main data show treatment gaps in metastatic NSCLC

Among the 254,611 patients included in the study, the median age was 73 years, and 52.5% were male. Most patients were White, accounting for 80.7% of the study population, while 10.4% were Black, 3.7% were Asian and 1.8% were Hispanic.

Researchers found that survival after diagnosis appeared closely tied to whether patients received treatment. Of the 100,367 patients who died within 90 days of diagnosis, only 13.2% received systemic therapy. By comparison, 69% of patients who survived longer than 90 days received treatment.

Chemotherapy was the most commonly used therapy, given to 95.3% of treated patients. Immunotherapy was used in 22.6% of treated patients, while 15.3% received targeted therapy.

Several factors were linked with a greater likelihood of treatment. Referral to an oncologist had one of the strongest associations with treatment receipt. Patients who saw an oncologist had a hazard ratio of 2.50 for receiving treatment, corresponding to a 30.3% greater cumulative incidence of treatment at 180 days compared with patients who were not referred.

Biomarker testing was also strongly associated with treatment receipt. Patients who underwent biomarker testing had a 17.8% greater cumulative incidence of treatment at 180 days compared with those who did not receive testing.

Age appeared to influence treatment rates as well. Among patients aged 65 to 69 years, 60.8% received treatment, while only 28% of patients aged 80 years and older did so.

Comorbidity burden also played a role. Among patients with no comorbid conditions, 52.8% received treatment compared with 30.6% of those with eight or more comorbidities.

Marital status and race were associated with differences in treatment rates. Married patients were more likely to receive treatment than unmarried patients, with rates of 52.1% versus 38.6%, respectively.

Black and Hispanic patients were less likely to receive treatment compared with White patients. Rural residence and lower income levels were also associated with lower treatment rates.

Researchers additionally identified a subgroup of patients who appeared more likely to be eligible for treatment, including those younger than 80 years, with three or fewer comorbidities and survival longer than 90 days after diagnosis. Among this group, 78.6% received treatment, meaning approximately one-fifth still did not receive systemic therapy despite favorable clinical characteristics.

Trial details explain how researchers evaluated treatment patterns

The population-based cohort study used linked data from the Surveillance, Epidemiology and End Results (SEER) database and Medicare claims records.

Researchers included patients aged 65 years and older who were diagnosed with metastatic NSCLC between Jan. 1, 2006, and Dec. 31, 2021.

The primary outcome was whether patients received at least one systemic treatment after diagnosis. Systemic therapies included chemotherapy, immunotherapy, targeted therapy and nonspecific systemic treatment. Radiation therapy and local treatments were not included because they generally were used for symptom relief rather than treatment of metastatic disease.

Investigators evaluated demographic and clinical factors associated with treatment receipt, including age, sex, race and ethnicity, marital status, rural versus urban residence, income level, comorbidity burden, histologic findings, Medicare coverage, biomarker testing and specialist referral.

Researchers also evaluated mortality and survival outcomes. Crude mortality rates at 30, 60 and 90 days were substantially lower among treated patients compared with untreated patients.

At one year, observed survival was 44.9% among treated patients compared with 7.7% among untreated patients. At five years, observed survival rates were 6.2% and 1.2%, respectively.

The authors noted that most patients who ultimately received treatment began therapy within approximately 100 days of diagnosis.

Safety and treatment considerations for older patients

The study did not directly compare specific side effects between therapies. However, researchers discussed how older chemotherapy regimens historically were linked with high rates of drug-related side effects and only modest survival improvements.

Investigators noted that newer therapies, including immunotherapy and targeted therapies, are generally more tolerable and may benefit patients who previously would not have been considered eligible for chemotherapy.

Researchers also highlighted that many patients with mNSCLC may have been too ill to safely receive treatment because of poor performance status, cancer progression or other serious health conditions. Approximately 39.8% of patients in the study died within 90 days of diagnosis.

The authors suggested that delays in diagnosis, biomarker testing and referral to oncology specialists may contribute to lower treatment rates and poorer outcomes for some patients.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

References

1. “Treatment Rates and Factors Associated With Systemic Therapy in Older Adults With Metastatic Non–Small Cell Lung Cancer” by Dr. John M. Williams, et al., JAMA Oncology.