Chemotherapy use and outcomes in patients with stage III or IV small-cell lung cancer in relation to age: An analysis of the English Systemic Anti-Cancer Treatment (SACT) dataset

TL;DR

This study examines chemotherapy use and outcomes in older versus younger patients with advanced small-cell lung cancer in England, finding that older patients received less curative treatment and had worse survival rates.

Contribution

The study provides real-world data on chemotherapy patterns and outcomes in older patients with advanced small-cell lung cancer using a national dataset.

Findings

Older patients were 6–7 times less likely to receive curative chemotherapy than younger patients.

Older patients had higher 90-day mortality rates and poorer overall survival compared to younger patients.

Survival outcomes declined around age 70–75 and were worse for patients with performance status scores ≥2.

Abstract

Background: We described patterns of chemotherapy use and outcomes in patients with advanced small-cell lung cancer (SCLC) in relation to age using the Systemic Anti-Cancer Treatment dataset.

Method: In total, 7,966 patients SCLC (67.6% stage IV) diagnosed between 2014–17 in England, treated with chemotherapy were followed up through 2017. Patterns of chemotherapy use, 30- and 90- mortality rates, and 6- and 12-month and median overall survival (OS) from the initiation of chemotherapy were compared between those below and above the age of 75.

Results: Older patients were 6–7 times less likely to receive curative treatment than younger patients regardless of stage. They had more frequent adjustments of treatment and dose reduction (stage III). There were no age differences in dose reduction in stage IV, treatment delayed or stopped earlier than planned. 30-day mortality rates were similar across age groups in stage III SCLC (~4%). Older patients had higher 90-days mortality rates and poorer OS than younger peers. In both stages, OS decreased around the age of 70–75 and were worse in patients with performance status scores ≥2.

Conclusion: This study offers a snapshot of chemotherapy use and outcomes in advanced SCLC, notably in older patients, in the pre-immunotherapy era.

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