Abstract
BackgroundAlthough lung cancer is most commonly diagnosed in elderly patients, evidence about tumor-directed therapy in elderly patients is sparse, and it is unclear to what extent this affects treatment and care. Our study aimed to discover potential disparities in care between elderly patients and those under 65 years of age.MethodsWe studied claims from 13 283 German patients diagnosed with lung cancer in 2009 who survived for at least 90 days after diagnosis. We classified patients as “non-elderly” (≤ 65), “young-old” (65–74), “middle-old” (75–84), and “old-old” (≥ 85). We compared receipt of tumor-directed therapy (6 months after diagnosis), palliative care, opioids, antidepressants, and pathologic diagnosis confirmation via logistic regression. We used generalized linear regression (gamma distribution) to compare group-specific costs of care for 3 months after diagnosis. We adjusted all models by age, nursing home residency, nursing care need, comorbidity burden, and area of residence (urban, rural). The age group “non-elderly” served as reference group.ResultsCompared with the reference group “non-elderly”, the likelihood of receiving any tumor-directed treatment was significantly lower in all age groups with a decreasing gradient with advancing age. Elderly lung cancer patients received significantly fewer resections and radiotherapy than non-elderly patients. In particular, treatment with antineoplastic therapy declined with increasing age (“young-old” (OR = 0.76, CI = [0.70,0.83]), “middle-old” (OR = 0.45, CI = [0.36,0.50]), and “old-old” (OR = 0.13, CI = [0.10,0.17])). Patients in all age groups were less likely to receive structured palliative care than “non-elderly” (“young-old” (OR = 0.84, CI = [0.76,0.92]), “middle-old” (OR = 0.71, CI = [0.63,0.79]), and “old-old” (OR = 0.57, CI = [0.44,0.73])). Moreover, increased age was significantly associated with reduced quotas for outpatient treatment with opioids and antidepressants. Costs of care decreased significantly with increasing age.ConclusionThis study suggests the existence of age-dependent care disparities in lung cancer patients, where elderly patients are at risk of potential undertreatment. To support equal access to care, adjustments to public health policies seem to be urgently required.
Highlights
Lung cancer was the fourth leading cause of death in Germany in 2016 [1]
Compared with the reference group “non-elderly”, the likelihood of receiving any tumordirected treatment was significantly lower in all age groups with a decreasing gradient with advancing age
Treatment with antineoplastic therapy declined with increasing age (“young-old” (OR = 0.76, CI = [0.70,0.83]), “middle-old” (OR = 0.45, CI = [0.36,0.50]), and “old-old” (OR = 0.13, CI = [0.10,0.17]))
Summary
Lung cancer was the fourth leading cause of death in Germany in 2016 [1]. Among all types of cancer, lung cancer accounted for the highest proportion of cancer-related deaths in men and the second highest in women [1]. In Germany in 2013, incidence rates ranged from 125 per 100 000 in 55- to 59-year-old men to 423 in 100 000 in 80- to 84-year-old men, and from 64 to 106 per 100 000 in women [5] Despite these numbers, historically, elderly patients are underrepresented in clinical trials [6]; evidence on treatment effects in this relevant patient group is insufficient. Elderly patients are underrepresented in clinical trials [6]; evidence on treatment effects in this relevant patient group is insufficient Efforts to address this issue by enrolling more elderly patients in clinical trials have been made [7] and, since the 1990s, numbers have improved [8]. Our study aimed to discover potential disparities in care between elderly patients and those under 65 years of age
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