Pneumologie 2018; 72(S 01): S37-S38
DOI: 10.1055/s-0037-1619215
Sektion 11 – Pneumologische Onkologie
Posterbegehung – Titel: Lungenkarzinom I
Georg Thieme Verlag KG Stuttgart · New York

Are elderly lung cancer patients treated differently? Results from a German claims data analysis

J Walter
1   Helmholtz Zentrum München GmbH; Institut für Gesundheitsökonomie und Management Im Gesundheitswesen
,
A Tufman
2   Division of Respiratory Medicine and Thoracic Oncology; Department of Internal Medicine V, Ludwig Maximilian University of Munich
,
L Schwarzkopf
3   Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Neuehrberg
› Author Affiliations
Further Information

Publication History

Publication Date:
21 February 2018 (online)

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Objectives:

Our study aimed to discover differences in tumor-directed and palliative treatment of elderly lung cancer patients compared to younger ones.

Materials and Methods:

We studied 13,283 patients with a first diagnosis of lung cancer in 2009, surviving for at least three months, in groups of 'young' (≤65 years), ‘young-old’ (65 – 74 years), ‘middle-old’ (75 – 84 years) and ‘old-old’ (≥85 years) from a German health insurance fund. We compared proportions of diagnostic biopsies performed after diagnosis (in untreated patients), treatment with chemotherapy, radiotherapy and tumor resection in the six months after diagnosis, and receipt of structured palliative care, opioids and antidepressants during the course of the disease using logistic regression. All models were adjusted by sex, nursing home residency, care level, Charlson index and rural or urban residence. Age group ‘young’ was used as reference group.

Results:

Receiving structured palliative care was less likely in ‘young-old’ (OR = 0.84, CI =[0.76, 0.93]), ‘middle-old’ (OR = 0.71, CI =[0.63, 0.80]), and ‘old-old’ (OR = 0.57, CI =[0.44, 0.74]). Treatment with opioids and antidepressants was significantly lower in all age groups, too. Diagnostic biopsies in patients without tumor-directed treatment were less frequent only in age group ‘old-old’ (OR = 0.60, CI =[0.40, 0.91]). The chance of not receiving any tumor-directed treatment was higher in ‘young-old’ (OR = 1.60, CI =[1.34, 1.92]), ‘middle-old’ (OR = 4.33, CI =[3.64, 5.16]) and ‘old-old’ (OR = 16.51, CI =[12.71, 21.46]), and that of receiving chemotherapy lower in ‘young-old’ (OR = 0.78, CI =[0.71, 0.84]), ‘middle-old’ (OR = 0.46, CI =[0.42, 0.51]) and ‘old-old’ (OR = 0.13, CI =[0.10, 0.17]). Radiotherapy was less likely in ‘middle-old’ (OR = 0.88, CI =[0.78, 0.98]), and ‘old-old’ (OR = 0.66, CI =[0.50, 0.87]), as was tumor resection in ‘middle-old’ (OR = 0.80, CI =[0.72, 0.89]) and ‘old-old’ (OR = 0.46, CI =[0.35, 0.62]).

Conclusion:

All in all, from these results we cannot infer directly that this means elderly lung cancer patients are undertreated or whether they just did not undergo treatments due to own preferences. However, there is a significant age gradient across all treatment aspects studied, and importantly these differences do already manifest starting from the age of 65 years onwards.