Lung cancer kills more Americans than any other cancer, so why do 21.6% of patients get no treatment at all?

An estimated 142,670 persons will die of lung cancer in the US in 2019, making it the leading cause of cancer-related deaths, says a study, which analyzed 441,812 lung cancer patients diagnosed between 2010-14.


                            Lung cancer kills more Americans than any other cancer, so why do 21.6% of patients get no treatment at all?

More people in the US die from lung cancer than any other type of cancer. And this is true for both men and women, according to the Centers for Disease Control and Prevention (CDC). However, just 6 in 10 lung cancer patients in the US receive minimal lung cancer treatments recommended by the National Comprehensive Cancer Network guidelines. Further, over 21% receive no treatment at all, shows analysis.

The likelihood of receiving the minimal treatments is even lower for black patients and the elderly, say researchers who based their findings on an analysis of 441,812 lung cancer patients diagnosed between 2010-2014 in the US National Cancer Database (NCDB). The team includes researchers from the Erasmus MC University Medical Center Rotterdam, the Netherlands, and University of Michigan, US.

The results of the analysis are concerning, say experts who found that between 2010-2014, many lung cancer patients in the US received no treatment or less intensive treatment than recommended.

"I think we have to be careful about over-interpreting survey results. It certainly suggests we need to look further into this, because there may be several legitimate reasons for treatment to deviate from published guidelines. Survey methods do not allow us to do deeper into these reasons", study co-author Dr. Douglas Arenberg, who is a professor of medicine and a pulmonologist at the University of Michigan, told MEA WorldWide (MEAWW).

Black and elderly patients are less likely to receive the recommended lung cancer treatments. (ATS)

Cancer is the second leading cause of death in the US, exceeded only by heart disease. One of every four deaths in the US is due to cancer, says CDC.

According to the study, published in the Annals of the American Thoracic Society, an estimated 142,670 persons will die of lung cancer in the US in 2019, making it the leading cause of cancer-related deaths. 

Top 10 cancers by rates of cancer deaths in the US, 2016 (male and female). The rates are the number of deaths) per 100,000 people. (Source: CDC)

An alliance of leading cancer centers, the National Comprehensive Cancer Network, has established clinical guidelines for treating both non-small cell lung cancer and small cell lung cancer. Together, the two types of lung cancer are the leading cause of cancer deaths in the US.

According to the researchers, the guidelines account for the stage of the disease when diagnosed and recommend more aggressive treatment of lung cancer in its early stages. Treatment for lung cancer includes surgery, chemotherapy, conventional radiotherapy, and stereotactic body radiation therapy, a specialized and precise type of radiotherapy that delivers high doses of radiation to small, well-defined tumors. Depending on the type of lung cancer and its stage, the guidelines may recommend combinations of these therapies, say experts.

Based on their analysis, the researchers found that, among the patients, 62.1% received guideline-concordant treatment, 21.6% received no treatment, and 16.3% of the patients received treatment that was less intensive than recommended. Conventional radiotherapy only was among the most common less-intensive-than recommended therapy across all stages of both cancers.

"There may be legitimate clinical reasons for deviating from published guidelines that are appropriate for any given clinical situation. The best person to determine treatment options for a patient is a qualified thoracic medical oncologist, and/or radiation oncologist, especially when it comes to unresectable stage III lung cancer", says Dr. Arenberg.

"Our concern is that there is some therapeutic nihilism that leads physicians to recommend less intensive therapy than otherwise might be appropriate, though we cannot even guess at how often that is the case. The worst-case scenario would be someone who is not even referred to a qualified oncologist to have these discussions. This was a small proportion of the patients, according to the responded center survey, but even that small proportion is too high, in my opinion. We simply do not want the reason for "less intensive" therapy to be that the treating clinician is unaware of the benefit of these treatments. We hope, and believe that this is rare," Dr. Arenberg told MEAWW. 

Treatment for lung cancer includes surgery, chemotherapy, conventional radiotherapy, and stereotactic body radiation therapy. Depending on the type of lung cancer and its stage, the guidelines may recommend combinations of these therapies, say experts. (Getty Images)

The findings show that those with advanced non-small cell lung cancer were the least likely to receive guideline-concordant treatment. Further, black patients were only 78% as likely to receive the minimum treatment compared to those who were white. Those aged 80 and older were only 12% as likely to receive the minimum treatment compared to those under the age of 50, the findings state.

The researchers stress the importance of communicating to patients that the benefits of cancer treatment for advanced diseases, such as chemotherapy, can extend beyond survival to quality of life and symptom control. According to Dr. Erik Blom, scientific researcher at the `Department of Public Health, Erasmus MC University Medical Center Rotterdam, knowing which patients are at risk of receiving less intensive treatment than recommended is an important first step towards creating targeted interventions to improve cancer care.

“Policymakers and hospitals may use this knowledge to develop and test targeted interventions for improving the uptake of the recommended treatments. For example, extra efforts could be made to follow-up with these specific patient groups after their diagnosis has been made. For doctors, awareness of this issue may increase the chance that they recognize and address any unjustified concerns that their individual patients may have regarding their treatment", Dr. Blom told MEAWW. Dr. Arenberg told MEAWW: "Because stage III lung cancer is potentially curable, and the highest cure rates are achieved with either combined concurrent chemoradiation therapy, or neoadjuvant chemotherapy with or without radiation, followed by surgery, a multidisciplinary team should discuss every patient's care prior to initiating therapy. And they should commit to the course of action that provides the greatest opportunity for cure, with the lowest possibility for treatment-related toxicity."

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