A large population-based study reveals that nearly half of older adults diagnosed with metastatic non-small cell lung cancer never received systemic therapy, highlighting a persistent treatment gap. The analysis of over 254,000 patients aged 65 and older, diagnosed between 2006 and 2021, found that only 46.8% ever received treatment. Rates increased only marginally despite newer, more effective therapies.
Early death remains a major barrier. Among the 100,367 patients who died within 90 days of diagnosis, only 13.2% received systemic therapy. Conversely, 69% of those surviving beyond 90 days were treated. Referral to an oncology specialist emerged as the strongest predictor of treatment, with a hazard ratio of 2.5. Biomarker testing also significantly boosted treatment rates.
Age and tumor histology further influenced access. Patients over 80 were 15.4% less likely to receive treatment within 180 days than those aged 65-69. Those with NSCLC not otherwise specified had a 12.8% lower rate than patients with adenocarcinoma. Other contributing factors included comorbidity burden, marital status, Medicare coverage type, rurality, and race.
Strikingly, about one in five patients with the most favorable clinical profiles still did not receive systemic therapy. This underscores a critical disconnect between therapeutic advances and real-world delivery for older adults with metastatic NSCLC.