Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database

摘要

To compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients. We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70?years old and non-elderly 70?years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone 59.4?Gy or chemoradiation (CRT)?59.4?Gy), or definitive treatment (RT alone?≥59.4?Gy or CRT?≥59.4?Gy). Differences in treatment between elderly and non-elderly were tested using the χ2 test. We identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P??0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P??0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P??0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P??0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P??0.0001 amongst all patients). In this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined.