Impact of Treatment Decisions on Survival Outcomes in Elderly Patients With Non–Small Cell Lung Cancer: A Retrospective Real-World Study

Aims: Lung cancer (LC) is a leading cause of cancer-related mortality, particularly in elderly patients, who often receive less curative treatment and have poorer prognoses than younger individuals. The reasons for these disparities remain unclear. This study aimed to identify clinical factors influencing treatment decisions and survival outcomes in elderly patients with non–small cell lung cancer (NSCLC). Materials and methods: This retrospective study included 395 NSCLC patients diagnosed in 2018 at five Finnish hospitals. Patients were divided into four age cohorts: <61, 61 to 70, 71 to 80, and >80 years. Overall survival (OS) was analysed across age groups, stratified by treatment methods. Results: Stage distribution was similar across age groups; however, older patients had worse performance status and higher Charlson Comorbidity Index (CCI) scores (P ≤ 0.008). Elderly patients were less likely to receive surgery, chemoradiotherapy, or chemotherapy and were more frequently offered best supportive care (BSC) (P < 0.013). OS decreased with increasing age (P = 0.006), with 1-year survival rates of 60% and 32% and 2-year survival rates of 41% and 15% in the youngest and oldest cohorts, respectively. LC was the leading cause of death across all age groups. Conclusion: Elderly NSCLC patients had poorer survival outcomes despite similar disease stage at diagnosis, possibly due to lower rates of curative treatment. These findings highlight the need for further investigation into optimising treatment strategies for elderly patients with NSCLC.