medwireNews: Between 2010 and 2014, more than a third of lung cancer patients in the USA received less intensive treatment than recommended, or indeed no treatment at all, shows an analysis of data from the US National Cancer Database.
Not receiving guideline-concordant treatment was particularly common among elderly patients and non-Hispanic Black people, regardless of their clinical subgroup, Erik Blom (Erasmus Medical Center, Rotterdam, the Netherlands) and co-authors report in the Annals of the American Thoracic Society.
They found that, overall, 16.3% of 441,812 individuals diagnosed with lung cancer between 2010–2014 received less intensive treatment than recommended, while 21.6% did not receive any treatment for their lung cancer.
Across clinical subgroups the proportion receiving less intensive treatment ranged from 6.4% in extensive-disease small-cell lung cancer (SCLC) to 21.6% in locally advanced non-small-cell lung cancer (NSCLC), while the proportions receiving no treatment ranged from 10.3% in localized NSCLC to 31.4% in advanced NSCLC.
The remaining 62.1% were treated in accordance with the guidelines, but the proportion still varied across the subgroups, ranging from 50.4% in advanced NSCLC to 76.3% in localized NSCLC.
Among the specific treatments recommended in the guidelines, conventionally fractionated radiotherapy alone was used less intensively than recommended across all clinical subgroups, with rates ranging from 2.5% for limited-disease SCLC to 16.0% for advanced NSCLC.
In addition, chemotherapy alone was underused in 1.2–13.7% of the nonmetastatic subgroups, while conventionally fractionated radiotherapy plus chemotherapy was used less intensively than recommended among 5.9% of patients with localized NSCLC.
Blom and team also investigated factors associated with receiving guideline-concordant treatment and found that, after adjustment for potential confounders including health insurance status, the likelihood decreased with increasing age, such that people aged 80 years and older were a significant 88% less likely to be treated in accordance with the guidelines than those younger than 50 years of age.
In addition, non-Hispanic Black people were a significant 12% less likely to receive guideline-concordant treatment than non-Hispanic White people, and the team notes that both of these disparities were present across all clinical subgroups.
The researchers accept that the study is limited by a lack of information about patient preferences or whether they were well enough to receive more intensive cancer treatment.
In a statement to the press, study co-author Douglas Arenberg (University of Michigan, Ann Arbor, USA) said: “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.”
He continued: “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.”
Nonetheless, Blom et al conclude that their findings could be used to “target interventions for improving the rate of lung cancer cases that receive guideline-concordant treatment and to reduce disparities.”
By Laura Cowen
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