Many elderly patients with non-small cell lung cancer (NSCLC) may not receive guideline-adherent first-line treatment, according to a study published in Lung Cancer

Researchers also found that guideline-adherent care is associated with better survival for elderly patients with NSCLC.

To evaluate adherence to first-line treatment guidelines, researchers reviewed data on 238 patients. They were 65 years of age or older and were diagnosed with NSCLC from 2016 to 2020. 

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In all, 56% of patients received guideline-adherent treatment according to disease stage. Guideline-recommended treatment was as follows:

  • For stage I disease, surgery was the primary recommendation, but stereotactic body radiotherapy was an option if surgery was considered high risk. Adjuvant chemotherapy was recommended for stage IB disease or when the tumor was larger than 4 cm, and postoperative radiotherapy was indicated in the case of positive margins if additional resection was impossible.
  • For stage II disease, surgery was the primary recommendation, followed by adjuvant chemotherapy. Chemoradiotherapy was an option if surgery was considered high risk.
  • For stage III disease, surgery plus neoadjuvant or adjuvant therapy was the primary recommendation. Chemotherapy was recommended if the tumor was not resectable or surgery was considered high risk. Chemoradiotherapy was the primary recommendation for stage IIIB disease. Individualized multimodal treatment was considered guideline adherent as well.
  • For stage IV disease, recommendations included targeted therapy, immunotherapy, chemotherapy, or a combination of these. Single-agent chemotherapy or reduced doses were not considered undertreatment. 

Guideline adherence decreased with age. Adherence was observed in 66.5% of patients ages 65 to 74 and in 33.3% of patients age 80 or older (P <.001). 

The median overall survival (OS) was 12.5 months, and OS increased with guideline adherence regardless of disease stage. 

For patients with stage I-II disease, the median OS was 63.2 months with guideline-adherent treatment and 26.5 months with non-adherent care (P <.001). For patients with stage III disease, the median OS was 42.2 months and 11.5 months, respectively (P <.001). For patients with stage IV disease, the median OS was 11.0 months and 1.4 months, respectively (P <.001). 

“About 10% of elderly NSCLC patients may benefit from more intensive guideline-adherent treatment,” the researchers wrote. “Rapid diagnosis, including early rehabilitation to avoid decreasing PS [performance status] and progressive disease, may also be important. In addition, geriatric evaluation within treatment assessment might reduce variations in clinicians’ treatment decisions in elderly NSCLC patients.”


Lindqvist J, Jekunen A, Sihvo E, et al, Johansson M, Andersen H. Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients. Lung Cancer. Published online July 12, 2022. doi:10.1016/j.lungcan.2022.07.006