Not all elderly lung cancer patients get recommended care

(Reuters Health) - Elderly lung cancer patients who are black or from less educated communities are less likely to get the combination of chemotherapy and radiation that’s linked to better survival odds, a U.S. study suggests.

When patients have advanced, inoperable lung cancer, simultaneous treatment with both chemotherapy and radiation is the standard of care, regardless of age, said lead study author Dr. Richard Cassidy of the Winship Cancer Institute at Emory University in Atlanta.

“However, this treatment can be very difficult for patients to complete and so doctors always consider the “full picture’ before recommending a certain type of therapy,” Cassidy said by email.

Even though more than one in three new lung cancers are diagnosed in patients 75 or older, research to date hasn’t offered a clear picture of how the combination of chemotherapy and radiation works for elderly patients, Cassidy and colleagues note in Cancer.

For the current report, researchers studied 12,641 patients who were at least 80 years old when diagnosed with advanced lung tumors between 2004 and 2014.

Overall, 7,921 patients, or 63 percent, received no treatment. After two years, only about 7 percent of these patients were still alive, compared with 31 percent of the people who received combined chemotherapy and radiation.

Black patients were 20 percent less likely than white patients to receive chemotherapy and radiation, the study found.

Patients from communities where more than one in five residents lacked a high school degree had 15 percent lower odds of getting this combination therapy.

At the same time, men were 40 percent more likely to get chemo and radiation than women.

The survival benefit associated with combination therapy persisted even after accounting for factors like age, sex, race, income, and individual tumor characteristics.

One limitation of the study is that researchers lacked data on the exact cause of death. It’s possible the survival benefits of cancer treatment might be influenced by other competing risks of mortality in this elderly population, the authors note.

Some patients also might have rejected treatment when it was offered to them, either out of concerns about side effects or for other reasons.

“There are several reasons related to socioeconomic factors,” said Dr. Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

“In many cases, African Americans are less likely to have the financial means to seek medical care, such as transportation and some out of pocket expenses, although they are covered by Medicare,” Murray, who wasn’t involved in the study, said by email.

Treatment disparities in the study might be explained in part by differences in cultural or community beliefs about how aggressively to attack tumors in old age, said Dr. Veena Shankaran of the Fred Hutchinson Cancer Research Center in Seattle.

“Many studies have shown that black patients have less access to cancer care and worse cancer outcomes than whites,” Shankaran, who wasn’t involved in the study, said by email. “This study suggests that the same is true in this elderly population of lung cancer patients.”

Given the better survival with chemotherapy and radiation, it makes sense to consider this option even for elderly patients, said Asal Johnson, a public health researcher at Stetson University in Florida who wasn’t involved in the study.

“Elderly patients and their physicians should not be discouraged or timid to try available and recommended treatment options, including combined chemotherapy and radiation therapy,” Johnson said by email. “Part of the disparities between older and younger patients can be eliminated if both doctors and patients avoid making conventional assumptions about treatment regimens for the elderly.”

SOURCE: Cancer, online January 8, 2019.