Patterns of treatment and survival among older patients with stage III non-small cell lung cancer
Introduction
Half of patients with non-small cell lung cancer (NSCLC) are aged 65 years or older at the time of diagnosis, whereas one in four is aged 75 years or older in the Netherlands [1]. Overall 5-year survival remains below 15% for patients with stage III NSCLC in daily clinical practice [2]. Concurrent chemoradiotherapy is considered standard treatment for patients with unresectable stage III NSCLC, as it results in a survival benefit of 5,7% at 3 years and 4,5% at 5 years compared to sequential chemoradiotherapy according to clinical trials [[3], [4], [5]]. In case of resectable stage IIIA NSCLC, surgery with adjuvant chemotherapy is considered standard treatment [[3], [4], [5]],[[3], [4], [5]]. Older and frail patients are often excluded from clinical trials as strict eligibility criteria such as performance status, age, and strict levels of organ function are retained in order to minimize the risk of complications [6]. Elderly patients with NSCLC receive standard treatment less often [[7], [8], [9]]. This could be explained by a lack of evidence to extrapolate treatment guidelines to older and vulnerable patients in everyday clinical practice. Despite this lack of evidence, modest increases in the application of chemoradiotherapy were seen for older patients over time in the Netherlands [2]. A recent retrospective study from our group indicated that survival among patients with unresectable stage III NSCLC ≥70 years in the southeastern part of the Netherlands was not significantly superior for those who received concurrent chemoradiotherapy as compared to sequential chemoradiotherapy and even radiotherapy alone. Also, severe comorbidity was associated with worse treatment tolerance and worse survival in case of concurrent and sequential chemoradiotherapy [10]. Therefore, it is important to assess patterns of treatment and survival in this heterogenous and older population in order to distinguish patient groups for optimal treatment strategies by patient and tumour characteristics.
The aim of this population-based study was to describe unselected patients with stage III NSCLC aged 65–74 years and those aged ≥75 years regarding patterns of treatment and survival in relation with patient and tumour characteristics in the Netherlands.
Section snippets
Methods
All patients diagnosed with stage III NSCLC during 2009–2013 who were aged 65 years or older were retrieved from the population-based Netherlands Cancer Registry. Patients diagnosed by autopsy were not included. Since 1989, trained registrars routinely collect data from medical records regarding patient and tumour characteristics of all newly diagnosed cancer patients in the Netherlands. These data are >95% complete and have national coverage. Vital status was retrieved from the nationwide
Results
In the Netherlands, 7039 patients aged 65 years or older were diagnosed with stage III NSCLC between 2009 and 2013 (Table 1). This population covers 11% of all primary lung cancer cases in the Netherlands between 2009 and 2013, and 29% of patients diagnosed with stage III NSCLC (Fig. 1).
Almost half of the study population was ≥75 years old (45% of stage IIIA and 44% of stage IIIB, Table 1). The proportion of patients with stage IIIA receiving chemoradiotherapy was significantly higher for those
Discussion
The aim of this study was to assess patterns of treatment and survival among unselected Dutch patients with stage III NSCLC by describing patients aged 65–74 years and those aged ≥75 years. Almost half of patients aged 65–74 years received chemoradiotherapy, while this was only one fifth among those aged ≥75 years. Higher survival rates were seen for patients aged 65–74 years compared to those aged ≥75 years, although differences between age groups largely disappeared after stratification for
Conflicts of interest
None declared.
Acknowledgements
We would like to thank the registrars at the Netherlands Cancer Registry and participating hospitals for the collection of patient data. In addition, we would like to thank the Aart Huisman Scholariship for Research in Geriatric Oncology.
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