Health care disparities among octogenarians and nonagenarians with stage III lung cancer. Issue 4 (8th January 2018) - Cassidy, Richard J.
Abstract : BACKGROUND: To the authors' knowledge, the practice patterns for patients aged more than 80 years with stage III non–small cell lung cancer (NSCLC) is not well known. The purpose of the current study was to investigate factors predictive of and the impact on overall survival (OS) after concurrent chemoradiation (CRT) among patients aged ≥80 years with American Joint Committee on Cancer stage III NSCLC in the National Cancer Data Base (NCDB). METHODS: In the NCDB, patients aged ≥80 years who were diagnosed with stage III NSCLC from 2004 to 2013 with complete treatment records were identified. Multivariable logistic regression and Cox proportional hazard models were generated and propensity score‐matched analysis was used. RESULTS: A total of 12, 641 patients met the entry criteria: 6018 (47.6%) had stage IIIA disease and 6623 (52.4%) had stage IIIB disease. The median age at the time of diagnosis was 83.0 years (range, 80‐91 years). A total of 7921 patients (62.7%) received no therapy. Black race (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.06‐1.43) and living in a lower educated census tract of residence (OR, 1.20; 95% CI, 1.03‐1.40) were found to be associated with not receiving care, whereas treatment at an academic center (OR, 0.80; 95% CI, 0.70‐0.92) was associated with receiving cancer‐directed therapy. Receipt of no treatment (hazard ratio [HR], 2.69; 95% CI, 2.57‐2.82) or definitive radiation alone (HR, 1.15; 95% CI, 1.07‐1.24) compared with CRT was associated with worse OS. On propensity score matching, not receiving CRT was found to be associated with worse OS (HR, 1.58; 95% CI, 1.44‐1.72). CONCLUSIONS: In this NCDB analysis, approximately 62.7% of patients aged ≥80 years with stage III NSCLC received no cancer‐directed care. Black race and living in a lower educated census tract were associated with not receiving cancer‐directed care. OS was found to be improved in patients receiving CRT. Cancer 2018;124:775‐84 . © 2018 American Cancer Society . Abstract : Octogenarians and nonagenarians with stage III non–small cell lung cancer appear to be underrepresented in clinical trials that have established concurrent chemotherapy and radiation as the standard of care. In this analysis of the National Cancer Data Base among patients aged ≥80 years with American Joint Committee on Cancer stage III non–small cell lung cancer, receipt of definitive chemoradiation was associated with improved overall survival, which was confirmed on multivariable and propensity score‐matched analysis. Greater than 60% of these elderly patients did not receive any cancer‐directed therapy, with black race and living in a lower educated census tract found to be risk factors for not receiving therapy, whereas treatment at an academic center was associated with receipt of chemoradiation.