METASTATIC NSCLC treatment remains underused among older adults, despite major therapeutic advances over 15 years.
Almost half of older adults diagnosed with metastatic non-small cell lung cancer never received systemic therapy in a large population-based cohort study, raising concerns about persistent treatment gaps in a disease with high mortality.
The analysis included 254,611 patients aged 65 years and older diagnosed with metastatic NSCLC between January 2006 and December 2021. Across the full cohort, only 119,197 patients, or 46.8%, ever received systemic treatment. Treatment rates increased only slightly over the study period, despite the emergence of more effective and better tolerated therapies.
Survival, Referral, and Testing Shaped Treatment Access
Early mortality strongly influenced treatment receipt. Among the 100,367 patients who died within 90 days of diagnosis, only 13.2% received systemic therapy. By contrast, 69% of patients who survived more than 90 days received treatment.
Referral to oncology specialists was one of the strongest factors associated with receiving systemic treatment. In the competing risk model, oncology referral was associated with a hazard ratio of 2.5, corresponding to a 30.3% greater cumulative incidence of treatment at 180 days compared with no referral.
Biomarker testing was also linked with higher treatment rates, with a 17.8% greater cumulative incidence of treatment at 180 days. These findings suggest that specialist evaluation and diagnostic workup remain central to whether older adults with metastatic NSCLC receive systemic therapy.
Older Age and Histology Influenced Metastatic NSCLC Treatment
Patients older than 80 years had a 15.4% lower cumulative incidence of treatment at 180 days compared with those aged 65–69 years. Patients with NSCLC not otherwise specified had a 12.8% lower cumulative incidence of treatment compared with those with adenocarcinoma histology.
Other factors associated with smaller but significant differences in treatment receipt included comorbidity burden, marital status, Medicare Part C or Part D coverage, rurality, and race and ethnicity.
Notably, approximately one-fifth of patients with the most favorable clinical profiles still did not receive systemic therapy. The findings point to a persistent disconnect between therapeutic advances and real-world treatment delivery for older adults with metastatic NSCLC.
Reference
Fox AH et al. Rates of systemic treatment for metastatic non-small cell lung cancer among older adults. JAMA Oncology. 2026;doi:10.1001/jamaoncol.2026.1080.
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