The Elderly are Less Likely to Receive Recommended Radical Radiotherapy for Non-small Cell Lung Cancer. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: McAleese, J.; Baluch, S.; Drinkwater, K.; Bassett, P.; Hanna, G.G.
• Is Part Of: Clinical oncology. Volume 29:Issue 9(2017)
• Page Start: 593
• Page End: 600
• Publication Date: 2017-09
• Subjects: Aged -- lung cancer -- radiotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2017.06.014
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: The National Institute for Healthcare Excellence recommends continuous hyperfractionated, accelerated radiotherapy (CHART), concurrent chemoradiation (cCRT) and stereotactic ablative radiotherapy (SABR) for appropriate patients with non-small cell lung cancer (NSCLC), but these are not universally available in all UK radiotherapy centres. Reduced access to these treatments may be contributing to reduced survival, with the concern that elderly patients are less likely to receive guideline-recommended therapy (GRT). Materials and methods: We report a prospective, UK national study of patients treated with curative-intent radiotherapy for NSCLC over a 2 month period. Clinical oncologists in all UK radiotherapy centres were contacted and asked to complete a proforma on all patients treated with curative-intent radiotherapy. Results: Three hundred and seventeen records were returned from 82% of centres. Only 49% (95% confidence interval 43–55%) of patients received the GRT for their tumour type. Patients aged 70 years or over were less likely to access GRT than those under 70 years (40% compared with 60%, P = 0.001), both as a result of clinicians offering therapy less frequently (52% compared with 65%, P = 0.03) and a higher refusal of therapy (22% versus 8%, P = 0.02). A reluctance to travel to a different centre was a key component of these decisions. SABR was delivered to only 52% of suitable patients, mainly because it was not available in the local centre. Conclusions: In this study of UK curative-intent radiotherapy practice, a lack of local access seems to limit uptake of advanced radiotherapy techniques such as SABR, especially for patients aged over 70 years. Highlights: Not all patients receiving curative radiotherapy for NSCLC access their guideline recommended therapy (GRT). Elderly patients were over 3 times less likely to access GRT, than younger patients. The factors affecting clinician and patient decision making around access are examined, including a lack of local service provision. Only 55% of patients eligible to have SABR received it. The primary reason was a lack of local availability.