Despite major advances that have made advanced lung cancer more treatable, fewer than half of older patients with the disease receive treatment \u2014 a gap experts say begins with late diagnoses and extends to barriers that persist even after cancer is found.<\/p>\n
According to a study<\/a> of 250,000 older adults ages 68 to 80 conducted from 2006 to 2021 and recently published in JAMA, only 46.8% of patients received systemic therapy for widespread non-small-cell lung cancer \u2014 the deadliest<\/a> form of cancer in the United States. A modest 3% increase was seen over that timeline.<\/p>\n A full third never saw an oncologist.<\/p>\n That\u2019s all despite numerous new drugs and therapies hitting the market over the same span that serve to enhance patients\u2019 quality and length of life even after the cancer has become metastatic.<\/p>\n Dr. Ariel Lopez-Chavez of Gibsonia, medical oncologist and director of the Precision Medicine and Developmental Therapeutics Cancer Clinic at the AHN Cancer Institute, has been studying this problem since the early 2020s. He believes a low lung cancer screening rate is one key player in low treatment rates for the progressed disease.<\/p>\n \u201cIt\u2019s probably under 10% of patients that are eligible for screening don\u2019t get screened to begin with. That\u2019s one of the reasons why people don\u2019t get treatment. And they get diagnosed way too late, when it may be too late to act,\u201d he said of the low-dose CT scan screening<\/a> typically available to those who have a 20 pack-year smoking history and are ages 50 to 80.<\/p>\n According to the CDC, \u201ca pack-year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 20 pack-year history by smoking one pack a day for 20 years or two packs a day for 10 years.\u201d<\/p>\n A full 40% of lung cancers have advanced to stage 4 by the time they\u2019re diagnosed, according to a 2015 study<\/a>. Around 40% of those studied passed away within three months of diagnosis. <\/p>\n \u201cWithout the screening, we don\u2019t know until people start having symptoms,\u201d said Lopez-Chavez. \u201cAnd once they have symptoms, then it starts getting more complicated.\u201d<\/p>\n But late diagnosis is only part of the problem.<\/p>\n Why people are not being treated \u2014 and what they In Lopez-Chavez\u2019s mind, emotional factors like shame regarding smoking-induced lung cancer (80% per the CDC), fear of perceived treatment side effects and general fatalism, alongside more tangible factors like barriers to access and lack of knowledge about treatments, may all work against patients getting treatment.<\/p>\n Access to financial resources and transportation also played a role in the numbers. Treatment likelihood was lower among patients who were unmarried, lived in a rural area, or were Black or Hispanic.<\/p>\n \u201cThey may think that all cancers are just treated with heavy-duty type of chemotherapy. They may recall seeing a movie in which people did really poorly and they had a miserable experience while they were getting treatment. And they may think if they\u2019re feeling bad right now because of the cancer, if they get treatment like that, they may just have a worse time and die in pain,\u201d he said.<\/p>\n But cancer treatment is constantly evolving.<\/p>\n \u201cIn each generation, the treatment(s) get more effective and with less side effects,\u201d said Lopez-\u00adChavez. \u201cIt\u2019s to the point that to some patients it\u2019s just like having another chronic disease. They\u2019re taking a pill and they\u2019re having other\u00adwise no symptoms or very minimal symptoms and being able to go to work, do all the regular activities without really noticeable (side effects) \u2014 very, very minimal.\u201d<\/p>\n Over the past 20 years or so, the outlook for advanced lung cancer patients has improved with the advent of targeted therapies and other nonchemotherapy treatments.<\/p>\n \u201cTargeted therapies are very unique because a lot of them are in the form of pills. There\u2019s no chemo,\u201d said Lopez-Chavez. \u201cAnd some of them will have extraordinary effectiveness. People that otherwise would just die in six months without treatment, they can get survivals of more than five years by just taking a pill.\u201d<\/p>\n Personal viability depends on biological factors that must be examined through a molecular test.<\/p>\n \u201cI was really surprised to see that nationwide the testing rates are low. You would think that they would be closer to 100% if they He says around 50% of patients are eligible for targeted therapies. Some who are not eligible can still benefit from immunotherapies like Keytruda, which helps the body\u2019s immune system fight off cancer.<\/p>\n \u201cWe have also seen amazing responses there as well \u2014 we\u2019re talking about three, four, five and more than five years just with immunotherapy. Not getting a lot of side effects: not losing their hair, not vomiting \u2014 nothing,\u201d he said. \u201cWe\u2019re talking about good quality of life when we\u2019re talking about targeted therapies, and even with immunotherapy, too.\u201d<\/p>\n Diagnosed with advanced lung cancer in 2021 after pursuing treatment for what she believed to be kidney stones, 63-year-old Ellwood City resident Carol Shablensky is living proof of the treatment advancements.<\/p>\n She first received a year\u2019s worth of chemo and radiation but has since enrolled in two different clinical trials providing access to experimental treatments through AHN\u2019s year-old partnership<\/a> with the national Tempus Time Trial program<\/a>.<\/p>\n \u201cI did not really think I was going to survive this long,\u201d Shablensky said. \u201cI figured a year or two at most, and it\u2019s kind of shocking to have made it the five years.\u201d<\/p>\n Lopez-Chavez champions the program\u2019s linking of patients like Shablensky with treatments that are not yet FDA-approved.<\/p>\n \u201cWe have the availability to bring some of those newer therapies to the patients now,\u201d said Lopez-Chavez. \u201cIn the old days, some of these trials would take months to open. We have sometimes very aggressive cancers that will grow really quickly, so a patient cannot be waiting months. Through this program, we have reduced the time that it takes us to open a trial to weeks.\u201d<\/p>\n
\ncould be missing<\/p>\n
\nare that important, right? But they\u2019re consistently under 40% or worse. Sometimes then you see analyses in which they\u2019re 20%,\u201d said Lopez-Chavez. \u201cSo it\u2019s just, \u2018How can that be?\u2019 I think that\u2019s one of the biggest problems that we have.\u201d<\/p>\n