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A national study by researchers at UC Davis Comprehensive Cancer Center has found that a significant number of lung cancer patients are not receiving treatment. Based on data between 1998 and 2012 from the National Cancer Database, 21 percent of patients (190,539) with non-small cell lung cancer (NSCLC) received no specific cancer treatment, such as chemotherapy, radiotherapy or surgery. Many of the untreated patients were women, elderly, minorities, low income and uninsured.

These findings are particularly problematic for patients with late-stage disease. The analysis showed the number of untreated patients with stage 3A and stage 4 NSCLC increased slightly during the study period. Compared to patients receiving standard therapies, overall survival rates of untreated patients were significantly lower. NSCLC kills about 158,000 people each year – more than any other cancer.

“We were able to identify a really large number of untreated patients who were statistically similar to patients who received standard therapies,” said Elizabeth David, an assistant professor of surgery and first author on the paper, published today in The Journal of Thoracic Oncology.

David said the finding raises the question: If the patients had similar demographic and clinical characteristics, could more of the untreated patients benefit from treatment?

“My hope is that this study will raise awareness among physicians and encourage them to reconsider fundamental decisions such as whether patients may be candidates for treatment or not,” David said. “While it’s not realistic to expect every patient to get treatment, we may be too easily deciding not to treat.”

Across all stages, survival was strongly associated with treatment. The median overall survival for patients with stage 3A NSCLC who received chemotherapy and radiation, and those who received no treatment, was 16.5 and 6.1 months, respectively. Stage 4 patients who received chemotherapy had a median survival of 9.3 months vs. 2 months for those who received no treatment.

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The study was based on data from the National Cancer Database, which is administered by the Commission on Cancer and the American Cancer Society. Though the results indicate many NSCLC patients are not receiving treatment, the actual motivations of patients and physicians are difficult to discern from the dataset.

David and colleagues believe a number of factors may play a role, including race, age and insurance status. Referral patterns may also have an effect, and follow-up studies are needed to evaluate the impact of access to care.

“Lung cancer still has a bad stigma, and I think that influences both patients and providers,” said David. “Efforts to lessen the stigma are ongoing, including educational and social media initiatives highlighting the fact that the number of lung cancer cases in people who have never smoked cigarettes continues to rise.”

David hopes the study will spur patients and providers to have more robust discussions about treatment options.

“I’m hoping providers consider these data timely and significant,” she said. “Not getting treated for this cancer is associated with dismal outcomes. Although more progress is needed, meaningful treatment options do exist, and they are easier to tolerate than they used to be. At a minimum, patients should be aware of these options and the risks and benefits associated with them.”

This study was funded by the National Institutes of Health, National Center for Advancing Translational Sciences (UL1 TR000002) and the Department of Surgery Outcomes Research Group.

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