In a cohort study reported in JAMA Oncology, Fox et al found that approximately half of older patients with metastatic non–small cell lung cancer (NSCLC) have received systemic therapy in the United States in recent years.
Study Details
The population-based study used linked Surveillance Epidemiology and End Results (SEER) and Medicare claims data for patients aged 65 years or older diagnosed with metastatic NSCLC from January 2006 to December 2021. The primary outcome measure was receipt of systemic treatment.
Key Findings
A total of 254,611 patients were included in the analysis. Median age was 73 years (interquartile range = 68–80 years), 52.5% were male, 3.7% were Asian, 10.4% were Black, 1.8% were Hispanic, 80.7% were White, and 3.4% were another or unknown race.
A total of 119,197 patients (46.8%) ever received systemic treatment. Among 100,367 (39.8%) who died within 90 days of diagnosis, 13.2% received systemic treatment, compared with 69% of those who survived more than 90 days.
The proportion of patients receiving systemic therapy increased from 44.8% in 2006 to a peak of 51.6% in 2019 and then declined somewhat during the years of the COVID-19 pandemic.
Competing risk models showed that referral to oncology specialists was associated with increased likelihood of systemic treatment (hazard ratio = 2.5, 95% confidence interval = 2.41–2.67, P < .001), with this finding corresponding to a 30.3% greater cumulative incidence of treatment at 180 days (CIF180) vs patients without an oncology specialist referral. Patients who received biomarker testing had a 17.8% greater CIF180 vs those who did not, and those older than 80 years had a 15.4% lower CIF180 vs those aged 65 to 69 years. Patients with NSCLC–not otherwise specified histologic findings had a 12.8% lower CIF180 compared with those with adenocarcinoma histology.
Other factors associated with significant but smaller differences in receipt of systemic treatment included comorbidity burden, marital status, Medicare Part C or Part D coverage, rurality, and race/ethnicity.
The investigators concluded: “In this cohort study of older adults with [metastatic NSCLC], despite advances in therapy in recent decades, almost half of patients never received systemic therapy, and the proportion treated only minimally improved over time. Approximately one-fifth of those with the most favorable clinical profiles did not receive systemic therapy.”
Adam H. Fox, MD, MS, and Gerard A. Silvestri, MD, MS, of Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, are the corresponding authors for the JAMA Oncology article.
DISCLOSURE: The study was funded by the American Cancer Society National Lung Cancer Roundtable through an unrestricted sponsorship by Amgen, Inc. For full disclosures of the study authors, visit jamanetwork.com.
