Patterns of chemotherapy use and outcomes in advanced non-small-cell lung cancer in relation to age in England: A retrospective analysis of the population-based Systemic Anti-Cancer Treatment (SACT) dataset

Objective We described the patterns of chemotherapy use and outcomes in patients diagnosed with stage III or IV non-small cell lung cancer (NSCLC) in England. Method In this retrospective population-based study, we included 20,716 (62% stage IV) patients with NSCLC diagnosed in 2014-17 treated with chemotherapy. We used the Systemic Anti-Cancer Treatment (SACT) dataset to describe changes in treatment plan and estimated 30 and 90-day mortality rates and median, 6- and 12-month overall survival (OS) using Kaplan Meier estimator for patients aged <75 and ≥ 75 by stage. Using flexible hazard regression models we assessed the impact of age, stage, treatment intent (stage III) and performance status on survival. Results Patients aged ≥ 75 years were less likely to receive 2 or more regimens, more likely to have their treatment modified because of comorbidities and their doses reduced compared to younger patients. However, early mortality rates and overall survival were similar across ages, apart from the oldest patients with stage III disease. Conclusion This observational study demonstrates that age is associated with treatment choices in an older population with advanced NSCLC in England. Although this reflecting a pre-immunotherapy period, given the median age of NSCLC patients and increasingly older population, these results suggest older patients (>75yrs) may need additional support to access more intense treatments that may influence overall survival.