Study found 21 percent went without therapy, even though it could boost their survival

January 20, 2017

FRIDAY, Jan. 20, 2017 (HealthDay News) -- Many U.S. patients with late-stage lung cancer do not receive treatments that could prolong their lives, a new study finds.

Researchers at the University of California, Davis Comprehensive Cancer Center analyzed 1998-2012 data from the U.S. National Cancer Database.

They found that more than one in every five patients with non-small cell lung cancer (NSCLC) -- by far the leading form of the disease -- did not undergo any treatment. That included chemotherapy, radiotherapy or surgery, the researchers said.

Many of the untreated patients were women, elderly, minorities, low-income and uninsured, according to the research team.

The researchers found that the number of untreated patients with late-stage NSCLC even rose slightly during the study period.

The reasons why some patients went untreated remain unclear, the researchers said.

"We were able to identify a really large number of untreated patients who were statistically similar to patients who received standard therapies," said study first author Dr. Elizabeth David, an assistant professor of surgery.

Treatment did seem important to patient outcomes, even if lung cancer was in its more advanced, late stages. Overall, survival rates of untreated patients with all stages of NSCLC were significantly lower than for those who received treatment, the researchers said.

For example, median survival among patients with stage 3 disease was 16.5 months for those who received chemotherapy and radiation, but only 6.1 months for those who received no treatment.

Median survival among patients with stage 4 disease was 9.3 months for those who received chemotherapy, but just 2 months for those who received no treatment.

Non-small cell lung cancer kills about 158,000 people each year in the United States, more than any other type of cancer.

"My hope is that this study will raise awareness among physicians and encourage them to reconsider fundamental decisions such as whether patients may be candidates for treatment or not," David said in a UC Davis news release. "While it's not realistic to expect every patient to get treatment, we may be too easily deciding not to treat."

Two lung cancer specialists said the study raises an important issue.

"While treatment isn't appropriate for every patient with lung cancer, patients should be aware that treatment options for lung cancer have improved, with new treatments offering both improved survival and improved tolerability, even in older patients," said Dr. Ann Tilley, a pulmonologist at Lenox Hill Hospital in New York City.

She advises that patients with advanced lung cancer always "consult with an oncologist who has expertise in treating lung cancer for a full discussion of their treatment options."

Dr. Nagashree Seetharamu is a medical oncologist at the Northwell Health Cancer Institute in Lake Success, N.Y.

She said the study "hints" that some patients may be missing out on treatment, but the research does have its flaws.

According to Seetharamu, the National Cancer Database -- the source of the study's data -- "lacks details" that might help explain the decision-making of the physicians involved in treating individual patients.

Also, she noted that since 2003, new "biologic" drugs that are different from standard chemotherapy have emerged to help treat advanced lung cancers. The new study "does not seem to have taken into account" these treatment options, Seetharamu said.

Study author David believes certain factors -- the stigma that still surrounds a lung cancer diagnosis, race, age and insurance status -- may play a role in decisions not to pursue treatment.

But she hopes doctors are alerted to the new findings.

"I'm hoping providers consider these data timely and significant," David said. "Not getting treated for this cancer is associated with dismal outcomes. Although more progress is needed, meaningful treatment options do exist, and they are easier to tolerate than they used to be. At a minimum, patients should be aware of these options and the risks and benefits associated with them."

The study was published Jan. 18 in The Journal of Thoracic Oncology.

More information

The U.S. Centers for Disease Control and Prevention has more on lung cancer.

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