Ageism in the management of lung cancer

Background: age-related differences in the treatment of lung cancer patients have been reported in the past, but most previous studies have not recorded case-mix factors, nor have they studied the impact of such ageism on survival. Methods: a questionnaire-based study of diagnostic and case-mix factors was carried out across 48 hospital Trusts in the UK between 1997 and 1998. We identified 1,652 patients and followed through with regard to their treatment and survival for 6 months after diagnosis. Results: the median age of the population was 69 years, and for this analysis, was divided into three age groups: under 65 years, 65-74 and 75 years and over. There were significant inverse correlations between age and histological diagnosis, any active treatment and survival, even when corrected for case-mix factors and non-cancer causes of death. For example, the surgical resection rate in patients with confirmed non-small cell lung cancer with good performance status, no chronic obstructive pulmonary disease and limited disease was 37% in the younger patients compared with 15% in those 75 and over. The overall mortality rates at 6 months ranged from 42% in patients under 65 to 58% in the over 75s. Conclusions: this national study of lung cancer care in the UK has shown large age-related differences in management and survival in patients with lung cancer, largely independent of case-mix factors. The reasons for this are complex but such under-treatment in the elderly may be one factor underlying the poor outcomes in lung cancer patients in the UK.