Despite advances in options in recent decades that have resulted in meaningful improvements in longevity and quality of life for many patients, about half of people diagnosed with metastatic non-small cell lung cancer never receive treatment.
Although it is difficult to know how many people had conditions too severe to treat by the time they were diagnosed, a significant minority appear to be good candidates for treatment. That means people who could have had more fun with family and friends just weren’t getting the systemic therapy that would have made it possible.
This surprising reality was quantified and characterized for the first time in a paper published on May 7th. JAMA Oncology. Lung cancer pulmonologists Gerald Silvestri, MD, and Adam Fox, MD, of the MUSC Hollings Cancer Center and Thoracic Oncology Research Group, led the research team on behalf of the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT), which funded the study.
Funding for this research from the American Cancer Society was critical because the findings are a wake-up call to the clinical community that an alarming number of patients with advanced lung cancer are not getting the chance to benefit from the latest treatments. ”
Dr. Robert Smith, American Cancer Society ACS NLCRT co-chair and study co-author
This statistic surprised Fox and Silvestri, who began their research with a different question.
“What we really wanted to look at was the prevalence of biomarker testing,” Fox said. Many new treatments for lung cancer target specific genetic mutations, and biomarker testing allows doctors to tailor treatments to patients.
“So we said, ‘Before we start looking at how many people are getting tested, we should start looking at how many people are being treated.'”
In speaking with colleagues from across the country, I felt that most oncologists believe that 80% to 90% of their patients are eligible for treatment.
And from an oncologist’s perspective, that’s probably about right, Fox says.
“If you see a medical oncologist, especially one who specializes in lung cancer, such as at a cancer center or specialty referral center, you are much more likely to receive treatment,” he said.
Unfortunately, the numbers show that many people don’t even see an oncologist.
“The key message for physicians is to get patients to an oncologist quickly so they can see if they are eligible for one of these new treatments,” Silvestri said.
These new treatments include targeted therapies against specific genetic mutations. However, almost all lung cancer patients should be able to receive immunotherapy even if they do not have any of these gene mutations.
However, many patients have advanced lung cancer symptoms that are too severe at the time of diagnosis and die before treatment can be selected and used. About 40% of patients in the study died within 90 days of diagnosis. This highlights the importance of screening for early detection of lung cancer and prompt referral of patients for a complete workup and treatment. For people who are not eligible for guideline-based screening, it is important not to ignore persistent, unexplained respiratory symptoms.
Silvestri and Fox are planning new research to dig into why people don’t seek treatment. This paper doesn’t answer that question, but they have some ideas based on their experience.
- Outdated expectations. “Gerald and I always have patients who say, ‘Oh, I remember when my mom or dad was diagnosed with lung cancer,’ and they go through chemotherapy and it just goes away,” Fox said. These patients are not wrong. Previous lung cancer treatments had severe side effects and were largely ineffective. However, this is not the case with new treatments, which have extended survival times by nearly seven years in some cases. However, that message may not be getting across to both patients and clinicians.
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Lack of social support. The paper argues that lack of transportation and treatment in under-resourced health facilities may also be contributing factors. The study found that married patients were more likely to receive treatment, which is consistent with existing research.
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Poor health. Treatment guidelines typically come from clinical trials in relatively healthy patients, with the exception of lung cancer, based on the theory that people with multiple health problems are less able to cope with toxic side effects.
The paper calls for the inclusion of people in poor health in clinical trials, given that immunotherapy has fewer side effects than traditional chemotherapy. Many more patients may benefit from these new treatments.
Researchers said there is much work to be done to change perceptions. The paper examined data from 2006 to 2021, from the time when chemotherapy was the main treatment, to the time when immunotherapy and targeted therapies became available. Still, the increase in people receiving treatment over time was “not surprising.”
“I think everyone is really excited about all the progress,” Fox said. “Still, we think there are gaps in implementation and there is certainly a lot of work to be done.”
To put that in perspective, Silvestri pointed out that more than 200,000 people will be diagnosed with lung cancer this year in the United States. Approximately 100,000 of these people have metastatic disease at the time of diagnosis, but only half receive treatment.
“Lung cancer remains the leading cause of cancer-related deaths in this country, with more Americans dying from this disease than the next two types of cancer combined,” he said. “The medical community has a responsibility to diagnose the disease early, provide prompt referral to an oncologist, and inform patients that they are aware of the available treatment options that can improve both quality of life and survival.”
sauce:
Medical University of South Carolina
Reference magazines:
Fox, oh Others. (2026) Rate of systemic treatment for metastatic non-small cell lung cancer in older adults. JAMA Oncology. DOI: 10.1001/jamaoncol.2026.1080. https://jamanetwork.com/journals/jamaoncology/fullarticle/2848634
