Clinicians should ensure that patients from disparate populations are being properly evaluated and thoroughly counseled by multidisciplinary teams before choosing to forego treatment for non-small cell lung cancer (NSCLC), according to researchers. A study published in the Journal of Thoracic Oncology showed a growing number of NSCLC patients with advanced disease who are opting to forgo treatment, their research also demonstrated that receiving standard of care treatment leads to a higher overall survival (OS) compared with not receiving treatment, indicating the need to educate patients and clinicians regarding the benefit of treatment.1

Standard treatment for patients with advanced disease often includes a combination of radiation therapy, chemotherapy, and/or surgery in highly selective circumstances. Despite these standard treatment guidelines, a substantial proportion of patients with NSCLC patients remain untreated. A group of California researchers led by Elizabeth A. David, MD, conducted a study to evaluate treatment trends and their association with OS on patients with NSCLC. The group queried the National Cancer Database (NCDB) for cases of biopsy-proven NSCLC from 1998 to 2012. 

The researchers found that 190,539 (21%) of patients received no treatment. For stage IIIA and IV, the proportion of untreated patients increased over the study period (1998-2012) by 0.21%. Untreated patients had significantly shorter OS regardless of stage. Propensity-matched analysis of 6144 stage IIIA patient pairs demonstrated a higher OS for patients treated with chemoradiation compared to no treatment (6.5 months vs 6.1 months). Similarly, stage IV patient pairs had a higher OS when treated with chemotherapy compared to no treatment (9.3 vs 2.0 months).

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1. David EA, Daly ME, Li CS, et al. Increasing rates of no treatment in advanced-stage non-small cell lung cancer patients: a propensity-matched analysis. J Thorac Oncol. 2017 Jan 18. doi: 10.1016/j.jtho.2016.11.2221 [Epub ahead of print]