According to a study published in the European Journal of Cardio-Thoracic Surgery, patients aged 80 years and older with non-small cell lung cancer (NSCLC) present less frequently with clinical stage IA NSCLC and are offered surgical intervention less often. This patient population is also commonly diagnosed with less accurate measures.
The researchers conducted a retrospective analysis to investigate lung cancer outcomes among elderly patients with NSCLC. The authors wrote, “Our objective was to uncover potential disparities that exist in the elderly population regarding stage at presentation and treatment administered. We also wanted to assess the impact of any disparities on overall outcomes.”
The analysis was comprised of patients within the National Cancer Database with NSCLC from 2004 to 2017. The researchers categorized eligible patients into two groups, designated as Group A: patients who were aged 70 to 79 years and Group B: patients who were aged 80 to 90 years. The two groups were compared with regard to demographics, clinical and pathologic stage, diagnosis, treatment, and survival. The researchers excluded patients who were diagnosed with multiple malignancies. The overall survival for each age group based on stage was estimated using Kaplan-Meier curves.
The analysis included 466,051 patients, including 317,494 patients in group A and 148,557 patients in group B. No clinically meaningful demographic variances were detected between the two groups. Group A included 53% males, and Group B contained 49% males. In both groups, Caucasians comprised 88% of the patient population, and adenocarcinoma was the primary histology.
The results revealed that compared with patients in Group A, fewer patients in Group B had positive histologic confirmation of their cancer (85.1% vs. 78.6%, respectively, P <.001, standardized mean difference [SMD]: 0.051), and a greater percentage of them were rather diagnosed via cytology or radiography (14.6% vs. 21.3%, respectively, P <.001, SMD 0.175). Additionally, when compared with Group A, fewer patients in Group B were diagnosed with clinical stage IA (17.3% vs. 15.0%, respectively, P <.001, SMD 0.079), and a greater percentage were diagnosed with clinical stage IV (42.0% vs. 44.3%, respectively, SMD 0.079).
The results also revealed that an estimated 82% of patients in Group B did not receive surgery for their cancer, including regional lymph node surgery, and this finding was clinically meaningful compared with an estimated 70.0% in A (P <.001, SMD 0.299). Compared with Group A, more patients in Group B did not receive any chemotherapy (43.9% vs. 56.6%, respectively, P <.001, SMD 0.465). Radiation therapy was administered to 37.9% of patients in Group B compared with 41% in Group A (P <.001, SMD 0.145).
The most common reason reported among patients who did not have surgery was that surgery was not part of the initially planned treatment (70.9% in Group B vs. 62.0% in Group A; P <.001; SMD, 0.299), and the second most common reason cited was contraindication due to patient risk factors such as advanced age or comorbidities (8.0% in B vs. 6.2% in A, P <.001, SMD 0.299).
Among patients in Group B, there was a worse overall survival for each clinical and pathologic stage compared with the younger group, according to Kaplan-Meier curves. In Group B, the 5-year survival for clinical stage l NSCLC was 35.0% versus 50.0% in Group A. For pathologic stage I, Group B had a 5-year overall survival of 50.0% compared with 60.0% in Group A. With increasing time from diagnosis, survival declined more rapidly in Group B compared with Group A, and comparable trends occurred for the other clinical and pathologic stages.
“Many advancements have been made in thoracic surgery within the last several decades, which have made it safer for older patients to undergo surgery,” the authors concluded. “Despite this, key disparities in lung cancer screening and treatment persist among the elderly population. Continuing screening beyond 80 years may address some of these disparities related to age and improve outcomes in this population.”
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