(ChemotherapyAdvisor) – Among older veterans with non–small-cell lung cancer (NSCLC), advancing age is a much stronger negative predictor of whether first-line guideline-recommended treatment is administered than comorbidity, investigators reported in the Journal of Clinical Oncology online March 26.
“Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit,” wrote Wang et al. from the San Francisco Veterans Affairs Medical Center, San Francisco, CA.
They assessed receipt of first-line guideline-recommended treatment for 20,511 veterans with NSCLC age ≥65 years in the Veterans Affairs (VA) Central Cancer Registry from 2003 to 2008. Patients were stratified by age (65 to 74, 75 to 84, ≥85 years), Charlson comorbidity index score (0, 1 to 3, ≥4), and American Joint Committee on Cancer stage (1 to 2, 3A to 3B, 3B with malignant effusion to 4). VA claims and registry data provided details on comorbidity and patient characteristics.
Results showed that 51% of patients with local disease, 35% with regional, and 27% with metastatic disease received guideline-recommended treatment. “Treatment rates decreased more with advancing age than with worsening comorbidity for all stages, such that older patients with no comorbidity had lower rates than younger patients with severe comorbidity,” they noted.
Specifically, 50% of patients with local disease age 75 to 84 years who had no comorbidity received surgery vs. 57% of patients age 65 to 74 years with severe comorbidity (P<0.001). Multivariate analysis demonstrated that age and histology remained strong negative predictors of treatment for all stages, whereas comorbidity and nonclinical factors had a minor effect.
“As NSCLC treatment regimens continue to improve, we will need to address treatment barriers that exist for healthy older adults and also determine ways to reduce the overtreatment of patients with serious comorbidity who are more likely to be harmed by aggressive treatment than to benefit,” they concluded.