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NSCLC survival improving in U.S.; older patients undertreated

Journal
JAMA Oncology
Reuters Health - 26/10/2021 - An analysis of non-small cell lung cancer (NSCLC) trends showed increased survival from 2010-2017, as well as increased incidence of stage 1 disease, likely reflecting improved evaluation of incidental nodules, researchers suggest.

However, the analysis also found that a smaller proportion of patients 65 and older received treatment for stage IV NSCLC.

"The 5-year survival rate was higher in our analysis than what has been reported before," Dr. Apar Kishor Ganti of the University of Nebraska Medical Center in Omaha told Reuters Health by email.

"The incidence of early-stage lung cancer was increasing and this has great promise for lung cancer screening," he said. "If screening is widely implemented, there is a potential that our outcomes...would be even higher than what we have reported."

That said, he noted, "a larger proportion of older patients did not receive treatment for their cancer. While this has been reported before, it highlights the importance of tailoring treatments for older patients. We hope that with advances in immunotherapy, this disparity will cease to exist."

As reported in JAMA Oncology, Dr. Ganti and colleagues conducted a cross-sectional epidemiological analysis from multiple registries and databases. Adults diagnosed with NSCLC identified by International Classification of Diseases for Oncology, Third Edition, morphology codes were included.

There were 1.28 million new NSCLC cases (53%, men; about 67%, 65 or older) recorded in the U.S. from 2010 to 2017.

During the same period, NSCLC incidence per 100,000 decreased overall from 46.4 to 40.9 - from 15.5 to 13.5 in those under age 65, and 259.9 to 230.0 in those 65 or older.

The incidence of stage II, IIIA, and IIIB NSCLC was stable. Stage IV incidence decreased slightly from 21.7 to 19.6; by contrast, stage I incidence increased from 10.8 to 13.2.

From 2010 to 2016, NSCLC prevalence per 100,000 increased from 175.3 to 198.3 (nationwide projection). The prevalence increased among younger patients (77.5 to 87.9) but decreased among older patients (825.1 to 812.4).

A period survival analysis showed that 26.4% of patients survived five years, which, as Dr. Ganti indicated, is higher than previously reported.

In addition, the proportion of stage I NSCLC treated with radiation as a single initial treatment rose from 14.7% in 2010 to 25.7% in 2016. However, also as indicated, those ages 65 and older with stage IV NSCLC were most likely to be untreated (38.3%).

Editorial coauthors Dr. James Mulshine of Rush University Medical Center in Chicago and Bruce Pyenson of Millman, Inc. in New York City, commented in an email to Reuters Health. "People have to recognize that (low) screening participation for eligible individuals means people are dying at a time when cure is possible," they said. "Lung cancer screening should be a fundamental strategic driver for population health."

"Most people at high risk for lung cancer feel well," they noted. "Screening occurs at a time in someone's life when preventive measures such as smoking cessation, increased physical activity, or improved diet could be life-saving."

"Emerging evidence demonstrates that a chest CT image not only finds early lung cancer, but also early chronic obstructive pulmonary disease and early coronary artery disease," they said. "A lesson emerging from the COVID experience is that screening needs to move out of hospitals to where it is more accessible in the communities and in free-standing centers."

"Payer organizations such as Medicare, Medicare Advantage plans, Accountable Care Organizations, Medicaid, and commercial insurers have been the most effective change agents for screening, but only when the payers have financial upside and downside risks for results," they added. "We desperately need population-level metrics for lung cancer screening. Waiting for electronic medical records for this work will mean failure."

The study was funded by Astra Zeneca. Dr. Ganti has received funds from the company; three coauthors were employees at the time of the study; and one coauthor is currently an employee.

SOURCE: https://bit.ly/3jHd8ts and https://bit.ly/3Gp12z3 JAMA Oncology, online October 21, 2021.

By Marilynn Larkin



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