METASTATIC non–small cell lung cancer (NSCLC) treatment reached fewer than half of older adults, despite major advances in systemic therapy.
A population-based cohort study of 254,611 patients aged 65 years and older with metastatic NSCLC found that only 46.8% ever received systemic therapy between 2006 and 2021. The findings highlight a persistent treatment gap in a patient population with high mortality and growing access to more effective, better tolerated therapies.
The analysis used linked Surveillance, Epidemiology, and End Results and Medicare claims data to assess systemic treatment rates, trends, and factors associated with treatment receipt. The cohort had a median age of 73 years, and 52.5% were male. Most patients were White, while 10.4% were Black, 3.7% were Asian, 1.8% were Hispanic, and 3.4% were another or unknown race.
Survival and Referral Shaped Treatment Access
Early mortality strongly influenced metastatic NSCLC treatment rates. Among the 100,367 patients who died within 90 days of diagnosis, only 13.2% received systemic therapy. By contrast, 69% of those who survived beyond 90 days were treated.
Referral to an oncology specialist was one of the strongest factors associated with systemic treatment. In the competing risk model, oncology referral was linked to a hazard ratio of 2.5 and a 30.3% higher cumulative incidence of treatment at 180 days compared with no referral. Biomarker testing was also associated with treatment, corresponding to a 17.8% higher cumulative incidence of treatment at 180 days.
Older Age and Histology Linked to Lower Rates
Patients older than 80 years had a 15.4% lower cumulative incidence of treatment at 180 days compared with those aged 65 to 69 years. Histologic classification also mattered, as patients with NSCLC not otherwise specified had a 12.8% lower cumulative incidence compared with those with adenocarcinoma.
Other factors, including comorbidity burden, marital status, Medicare Part C or Part D coverage, rurality, and race and ethnicity, were associated with smaller but significant differences in treatment receipt.
Despite therapeutic progress, metastatic NSCLC treatment rates improved only slightly over the study period. Notably, approximately one-fifth of patients with the most favorable clinical profiles still did not receive systemic therapy, underscoring the need to understand barriers between diagnosis, oncology referral, biomarker testing, and treatment initiation.
Reference
Fox AH et al. Rates of systemic treatment for metastatic non–small cell lung cancer among older adults. JAMA Oncol. 2026;doi:10.1001/jamaoncol.2026.1080.
Featured Image: doctor consulting older patient on Adobe Stock.
