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Older, sicker patients less likely to get recommended therapies
Landrum MB. Cancer. 2011;doi:10.1002/cncr.26628.
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Physicians tended not to order recommended therapies for colorectal and lung cancer to patients who were elderly or had comorbidities, according to a review of medical records collected in the VA Central Cancer Registry.
Patients (n=584) diagnosed with non–small cell lung cancer or colorectal cancer from 2003 to 2004 who were eligible for one of four guideline-recommended treatments — curative surgery for stage I/II NSCLC, curative surgery for stage I to III rectal cancer, adjuvant radiation therapy for stage II/III rectal cancer and adjuvant chemotherapy for stage III colon cancer — were included in the analysis. Researchers used the Adult Comorbidity Evaluation-27 instrument to collect comorbidity information.
Researchers found that underuse rates ranged from roughly 20% for adjuvant radiation therapy for stage II/III rectal cancer to 35% for surgery for stage I/II NSCLC. More than 92% of patients said they were referred to a cancer specialist, and 88% to 99% went on to subsequent evaluation. However, the specialist recommended therapy in only 74% to 92% of cases, and patients received therapy only 69% to 85% of the time.
There were no racial disparities for access, recommendation or receipt of chemotherapy in stage III patients with colon cancer or in access or recommendations for surgery for stage I to III rectal cancer, but black patients were less likely to receive rectal surgery (66.6% vs. 80.7%). Black and white patients with stage I/II lung cancer were referred to a surgeon in equal rates, but blacks were less likely to be evaluated (87.1% vs. 95.6%), less likely get a recommendation for surgery (58.6% vs. 76.4%) and less likely to undergo surgery (53.2% vs. 72.5%), according to results in the study.
Older patients with stage I/II NSCLC were less likely than younger patients to be evaluated by a surgeon. Advanced age, comorbid illness, poor performance status and/or poor lung function was the listed reason for lack of therapy in more than 60% of patients with early-stage lung cancer who did not receive surgery, and in 15% to 33% of underuse cases in the other disease cohorts.
Age-related and race-related disparities remained even after controlling for comorbidity.
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