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This study examines age- and sex-related disparities in adherence to treatment guidelines for patients with non-small cell lung cancer.

Adherence to treatment guidelines for non-small cell lung cancer (NSCLCL) decreases with increasing patient age. However, gender disparities are also present, and have not been studied in as much detail. Women with NSCLC tend to have better survival rates, although other factors related to the disease vary. For example, the overall incidence of lung cancer in males has decreased in the 21st century, but the opposite has been found in women. 

Treatment for NSCLC includes surgical resection, chemotherapy, targeted therapy, immunotherapy, radiotherapy, and chemoradiotherapy. Treatment can vary widely based on age, and older women tend to be underrepresented in clinical trials, which may affect the overall understanding of treatments available to clinicians. This study, published in Cancer Treatment and Research Communications, analyzes the impact of sex and age on adherence to treatment guidelines. 

Age- and Sex-Related Adherence Variations

This study relied on data from a single hospital, and included patients with NSCLC who received first-line treatment between 2016 and 2020. Guideline adherence, defined as adherent, undertreatment, or overtreatment considering performance status, was used as the primary outcome. A total of 321 patients were included in the study. The highest rate of non-adherence was found in women aged 75 years or older, at 41.3%, followed by men in the same age range, at 32.6%. Non-adherence was associated with poor pulmonary function, stage III disease, and Charlson Comorbidity Index score of 1–2. 

These results suggest that sex-related disparities in guideline adherence are present in patients younger than 75 years of age and that undertreatment occurs in patients 75 even after performance status is considered. Frequency of overtreatment was highest in women < 75 years and frequency of undertreatment was highest in men < 75 years. All patients in the 75 and over category were more likely to receive non-adherent care. The complexity of treating stage III disease may contribute to higher rates of non-adherence. The cause of non-adherent care in men under 75 years warrants additional study.

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Paakkola, N., Lindqvist, J., Jekunen, A., Sihvo, E., Johansson, M., & Andersén, H. (2023). Impact of sex and age on adherence to guidelines in non-small cell lung cancer management. Cancer Treatment and Research Communications, 34, 100675. https://doi.org/10.1016/j.ctarc.2022.100675