ArticleERJ open research2021
Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?
Article in ERJ open research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Epidemiology of cancer in older adults: a systematic review of age-related differences in solid malignancies treatment.Current oncology reports · 2025Pooled it
- Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Pooled it
- Trends in Chronic Myeloid Leukemia Mortality by Race, Age, and Gender in the United States Between 1999 and 2020.Cureus · 2026Article
- Impacts of Multidisciplinary Lung Cancer Meeting Presentation in a Clinical Quality Registry.JTO clinical and research reports · 2026Article
- Confronting nihilism and stigma in lung cancer: The nurse practitioner's role in restoring hope and trust.Journal of the American Association of Nurse Practitioners · 2026Article
- Article
- Age-related differences in clinical characteristics and survival in lung cancer.Frontiers in oncology · 2026Article
- Prevalence of multiple lung diseases among the people and associated with wealth status and behavior factors: a longitudinal study in West Bengal.Journal of health, population, and nutrition · 2025Article
- Utilization of Lung Cancer Registries in Learning Health Systems for Health Care Improvement.JCO clinical cancer informatics · 2025Review
- Older Adult Participation in Early-Phase Lung Cancer Clinical Trials, 1998 to 2020.JTO clinical and research reports · 2025Article
- Aging-Related Mechanisms Underlying Carcinogenesis: Therapeutic Opportunities.Aging and disease · 2025Review
- Impact of Stage-Specific Guideline Concordant Treatment in Small Cell Lung Cancer in Victoria, Australia.Thoracic cancer · 2025Article
- Prognosis of non-small cell lung cancer patients undergoing compromised wedge vs. segmental resection: a population-based cohort study.Journal of cardiothoracic surgery · 2025Article
- Impact of age on clinical outcomes among patients with hepatocellular carcinoma: A systematic review and meta-analysis.JHEP reports : innovation in hepatology · 2025Article
- Tracheal, bronchus, and lung cancer among older adults: thirty-year global burden trends, precision medicine breakthroughs, and lingering barriers.BMC cancer · 2025Article
- Very Early Health Technology Assessment for Potential Predictive Biomarkers in the Treatment of Advanced Non-Small Cell Lung Cancer.PharmacoEconomics - open · 2025Article
- Patient- and Areal-Level Risk Factors Associated With Lung Cancer Mortality in Victoria, Australia: A Bayesian Spatial Survival Analysis.Cancer medicine · 2024Article
- Survival with primary lung cancer in Northern Ireland: 1991-1992.Irish journal of medical science · 2024Article
- Multiomics-Based Feature Extraction and Selection for the Prediction of Lung Cancer Survival.International journal of molecular sciences · 2024Article
- Impact of lung cancer screening with low-dose chest computed tomography on an older population: a retrospective cohort study.Translational lung cancer research · 2023Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Treatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly; potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with lung cancer and explore potential causes for excess mortality. Patients diagnosed with lung cancer in the Victorian Lung Cancer Registry between 2011-2018 were analysed (n=3481). Patients were age-categorised and compared using Cox-regression modelling to determine mortality risk, after adjusting for confounding. Probability of being offered cancer treatments was also determined, further stratified by disease stage. The eldest patients (≥80 years old) had significantly shorter median survival compared with younger age groups (<60 years: 2.0 years; 60-69 years: 1.5 years; 70-79 years: 1.6 years; ≥80 years: 1.0 years; p<0.001). Amongst those diagnosed with stage 1 or 2 lung cancer, there was no significant difference in adjusted-mortality between age groups. However, in those diagnosed with stage 3 or 4 disease, the eldest patients had an increased adjusted-mortality risk of 28% compared with patients younger than 60 years old (p=0.005), associated with markedly reduced probability of cancer treatment, after controlling for sex, performance status, comorbidities and histology type (OR 0.24, compared with <60 years old strata; p<0.001). Compared to younger patients, older patients with advanced-stage lung cancer have a disproportionately higher risk of mortality and lower likelihood of receiving cancer treatments, even when performance status and comorbidity are equivalent. These healthcare inequities could be indicative of widespread treatment nihilism towards elderly patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.