Lung cancer outcomes in the elderly: potential disparity in screening

Abstract

OBJECTIVES To analyze outcomes of lung cancer in the elderly METHODS A retrospective analysis was performed of patients in the National Cancer Database with NSCLC from 2004–2017 grouped into two categories: 70–79 years (A) and 80–90 years (B). Patients with multiple malignancies were excluded. Kaplan–Meier curves estimated the overall survival for each age group based on stage. RESULTS In total, 466,051 patients were included. Less invasive techniques (imaging & cytology) diagnosed cancer as a function of age: 14.6% in A vs 21.3% in B (p < 0.001, SMD 0.175). Clinical stage IA was least common in B (15%) compared to 17.3% in A (p < 0.001, SMD 0.079). Approximately 83.0% in B didn’t receive surgery compared to 70.0% in A (p < 0.001, SMD 0.299). Of the 83.0%, 8.0% were considered poor surgical candidates because of age or comorbidities compared with 6.2% in A (p < 0.001, SMD 0.299) For 71.0% in B, surgery was not the first treatment plan compared to 62.0% in A (p < 0.001, SMD 0.299). Survival curves showed worse prognosis for each clinical and pathologic stage for B compared to A. CONCLUSIONS Patients older than 80 years present less frequently as clinical stage IA, are less commonly offered surgical intervention, and are more frequently diagnosed using less accurate measures. They also have worse outcomes for each stage compared to younger patients.