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Balancing the benefits versus the harms of cancer therapies becomes increasingly complex with an aging population with multiple comorbidities but also newer therapeutic options. A SEER and Medicare database of extensive-stage small cell lung cancer (ES-SCLC) in more than 15,000 elderly patients found decreased use of antineoplastics and healthcare spending yearly from 2001 to 2013.

The associated factors for these declines include advanced age, living in high-poverty and rural areas, black and Hispanic ethnicity, and higher comorbidity index. Not all these factors need to restrict appropriate patient care. Specifically, we should be addressing provider awareness of financial burdens, systemic policies to drive down drug costs, access to care, patient compliance, and patient healthcare literacy. Chronologic age should not be the sole factor against antineoplastic therapies. Instead, adjustments to supportive care and less toxic options should be regularly considered in our elderly frail population.

Claire L. Hiles, MD, is a hematologist/oncologist at David Grant Medical Center at Travis AFB in California.

Read the study abstract here and an interview with the lead author here.