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Rates of Non–Guideline-Concordant Lung Cancer Treatment in the United States


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Only about 6 in 10 patients with lung cancer in the United States receive the minimal lung cancer treatments recommended by National Comprehensive Cancer Network® (NCCN) Guidelines, according to new research published by Blom et al in the Annals of the American Thoracic Society.

Erik F. Blom, MD, and colleagues reported that the likelihood of receiving the minimal treatments is even lower for black and elderly patients. The researchers based their findings on an analysis of 441,812 lung cancer cases diagnosed between 2010 and 2014 in the National Cancer Database.

“Comparability and generalizability of previous findings on this topic were limited,” said Dr. Blom, a researcher in the Department of Public Health at the Erasmus MC University Medical Center Rotterdam, who had a guest affiliation with the University of Michigan for this project. “We felt that it [was] important to investigate whether these disparities persist and whether they extend to all clinical subgroups of [patients with] lung cancer.”

Results

Among the patients in the database, 62.1% received guideline-concordant treatment, 21.6% received no treatment, and the remainder received treatment that was less intensive than recommended. Conventional radiotherapy only was among the most common therapy that was less intensive than recommended across all stages of both cancers.

KEY POINTS

  • Among the patients in the database, 62.1% received guideline-concordant treatment, 21.6% received no treatment, and the remainder received treatment that was less intensive than recommended.
  • After adjusting for factors that might have biased results, black patients were 78% as likely to receive the minimum treatment compared to those who were white. Those aged 80 and older were 12% as likely to receive the minimum treatment compared to those under the age of 50.

Patients with advanced non–small cell lung cancer were the least likely to receive guideline-concordant treatment. The researchers stressed the importance of communicating to patients that the benefits of cancer treatment for advanced disease, such as chemotherapy, can extend beyond survival to quality of life and symptom control.

After adjusting for factors that might have biased results, black patients were 78% as likely to receive the minimum treatment compared to those who were white. Those aged 80 and older were 12% as likely to receive the minimum treatment compared to those under the age of 50.

Study limitations include the fact that the database contained no information about patient preferences or whether they were too ill to receive more intensive cancer treatment.

“While these findings are very concerning, it has always been easier to identify disparities in care than it has been to understand why they persist,” said study coauthor Douglas Arenberg, MD, Professor of Medicine and pulmonologist at the University of Michigan. “There may be good reasons why less intensive treatment is in fact medically appropriate. The National Cancer Database does not include that level of detail.”

Still, Dr. Blom said, awareness of which patient groups are at risk of receiving less treatment than recommended could be a first step toward creating targeted interventions to improve cancer care.

Disclosure: For full disclosures of the study authors, visit atsjournals.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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