Findings Emphasize the Importance of Pursuing Treatment for Late-Stage Lung Cancer

A recent study, published in the Journal of Thoracic Oncology, shows that a significant number of lung cancer patients are not receiving treatment.

UC Davis Comprehensive Cancer Center researchers evaluated data from 1998 to 2012, from the National Cancer Database. Researchers found that 21 percent of patients with non-small cell lung cancer (NSCLC) has not received any specific cancer treatments — chemotherapy, radiotherapy or surgery.

Many of the patients in that population were women, elderly, minorities, of low income or uninsured.

This pattern is especially relevant to patients with late-stage disease in lung cancer. During the study period, the number of untreated patients with stage 3A and stage 4 NSCLC increased. Additionally, the overall survival rates of untreated patients compared to those receiving standard therapies were significantly lower.

Elizabeth David, M.D., F.A.C.S., stated that there was a “large number of untreated patients who were statistically similar to patients who received standard therapies.” From this, she raised the question: If patients had similar demographic and clinical characteristics, could more of the untreated patients benefit from treatment?

“While it’s not realistic to expect every patient to get treatment, we may be too easily deciding not to treat,” David, assistant professor of surgery at UC Davis Medical Center and first author of the paper, said.

The median survival for patients with stage 3A NSCLC who received chemotherapy and radiation is 16.5 months. For those who received no treatment, the median overall survival was 6.1 months.

Patients with stage 4 NSCLC who had received chemotherapy had a median overall survival of 9.3 months, while those without treatment had a median overall survival of two months.

The researchers noted that they cannot discern the motivations of the patients or physicians from this dataset.

There are a number of factors that could play a role in the decision, according to the researchers, including race, age, insurance status or referral patterns. The researchers suggested future studies to examine the impact of access to care in this issue.

David also mentioned the existence of stigma for patients with lung cancer. “I think that influence both patients and providers. Efforts to lessen the stigma are ongoing, including educational and social media initiatives highlighting the fact that the number of lung cancer cases in people who have never smoked cigarettes continues to rise.”

David said, “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 treatments or not.” She went on, “I’m hoping providers consider these data timely and significant. 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.”

David believes that patients should at least be made aware of the options for treatment and the risks and benefits that come with each.