By Lisa Rapaport

(Reuters Health) – Only about 60% of lung cancer patients get recommended treatments like chemotherapy and radiation that are linked to better survival odds, and a new study suggests rates are even lower for black and elderly patients.

Researchers examined data on 441,812 patients diagnosed with lung cancer between 2010 and 2014. Overall, almost 22% received no treatment at all. Another 16% received less intensive treatment than National Comprehensive Cancer Network guidelines recommend for optimal survival odds.

Compared to patients under age 50, people 80 and older were 88% less likely to receive optimal recommended treatment.

And compared to white patients, black patients were 22% less likely to get recommended treatments, while Hispanic patients had an 8% lower chance of this.

“While these findings are very concerning, it has always been easier to identify disparities in care than it has been to understand why they persist,” said Dr. Douglas Arenberg, a co-author of the study and a pulmonologist at the University of Michigan in Ann Arbor.

“There may be good reasons why less intensive treatment is in fact medically appropriate,” Arenberg said in a statement. “The National Cancer Database does not include that level of detail.”

Data were lacking on individual patient preferences, and it’s possible that at least some people opted against treatment or against more intense or aggressive treatment, the researchers note in the Journal of the American Thoracic Society. Some patients may have been too sick for intensive treatment, but this information was lacking, too.

It’s also possible that some treatment disparities in the study might be partly due to differences in cultural or community beliefs about how aggressively to treat cancer or how much intensive treatment makes sense for elderly patients, the study team notes.

And other factors that might impact treatment choices such as access and affordability of care weren’t examined in the study.

Even so, the results offer fresh evidence that many lung cancer patients are missing out on treatments that might help them live longer, researchers conclude.

The study focused on guidelines for treating either non-small cell lung or small cell lung cancer. Together, the two types of lung cancer are the leading cause of cancer deaths in the U.S.

The guidelines recommend more aggressive treatment of lung cancer in its early stages. Treatments can include 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.

One of the most common less-intensive-than-recommended approaches across all stages of both types of lung cancer was to treat patients with conventional radiotherapy alone, without other therapies, the study found.

Patients with advanced non-small cell lung cancer were the least likely to receive guideline-concordant treatment. The researchers stress the importance of communicating to patients that the benefits of cancer treatment for advanced disease, such as chemotherapy, can extend beyond survival to quality of life and symptom control.

SOURCE: Annals of the American Thoracic Society, online November 1, 2019.