Abstract
SCLC represents one of the most aggressive cancers with limited treatment options. Chemotherapy with or without radiation therapy remain the backbone treatment for this challenging disease. The impact of age and other socioeconomic factors on treatment modalities and clinical outcomes remain largely unknown. This study investigates the demographic, clinical, socioeconomic, and treatment modalities in each age group and the impact of patients’ age on survival. The National Cancer Database with NSCLC incident cases between 2004-2014 was used. Clinical factors including Charlson-Deyo comorbidity score, TNM staging, tumor histology, and type of treatment, demographic features, socioeconomic status and overall survival (OS) were analyzed by age of diagnosis, accounting for multivariate factors in NCDB. A total of 214,096 SCLC patients were included in the analysis. Median age at diagnosis was 67 years old (y/o). OS including all stages is 10.97 months for <60 y/o; 9.43 months for 60-69 y/o; 7.20 months for 70-79 y/o and 3.42 months for ≥80 y/o respectively (p<0.0001). The impact of age on survival is more prominent in stage I, II and III patients than those in stage IV patients. Patients ≥80 y/o are associated with significant smaller tumor size (41 mm vs 50 mm, p<0.0001) and more stage I cancer at diagnosis (3.8% vs 6.9%, p<0.0001) compared to patients <60 y/o respectively. Patients ≥ 80 y/o are associated with high income, high education and Pacific geographic region. Hispanics, Asians, females, and patients younger than 60 y/o are independently associated with improved OS. Despite comparable comorbidity, patients with ≥80 y/o are treated differently and received much less aggressive therapy including radiation therapy and/or chemotherapy at each stage (p<0.0001). The overall survival of SCLC is significantly impacted by patient’s age and socioeconomic factors. In particular, elderly patients are associated with significantly smaller tumor size, more stage I at diagnosis, however, they are under-treated and have worse survival compared to younger patients.
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