1365P - Does cancer care differ for older adults with lung cancer living with and without Alzheimer disease and related dementias (ADRD)?

Background

Lung cancer is the leading cause of cancer deaths globally, with an average age at diagnosis of 70. Lung cancer and Alzheimer Disease Related Dementia (ADRD) occur frequently in older adults, but little is known about the impact on care or treatment. The purpose of this study was to characterize patterns of treatment and healthcare utilization among older adults diagnosed with lung cancer with and without concomitant dementia.

Methods

We used the Surveillance Epidemiology and End Result (SEER) registry linked with Medicare data to conduct a retrospective cohort study of adults ≥66 years diagnosed with non-small cell lung cancer (NSCLC) between 2011 and 2017. We estimated dementia prevalence using the Bynum 1-year algorithm and evaluated use of cancer surgery, chemotherapy, immunotherapy, radiation, and healthcare utilization for 1-year following diagnosis or until death. We used t-tests and chi-square tests to evaluate significant differences between individuals with and without ADRD in stages I-III and IV.

Results

Stage IV NSCLC was more prevalent (n=46,987) than stage I-III (n= 40,084), but both groups had similar ADRD prevalence rates (3.43% stage I-III, 3.25% stage IV). Regardless of cancer stage, ADRD cohorts had higher prevalence of Spanish, Hispanic, or Latino and Black or African American individuals. Older adults with ADRD were significantly less likely to receive systemic drug therapy, especially for those with Stage IV cancer. Stage I-III (ADRD 12.14; non ADRD 29.65) X ² (1, N=40,084) =197.79, p<.01 and Stage IV (ADRD 14.95; non ADRD 40.63) X ²⁼ (1, N=46,987) = 405.97, p<.01. Overall, individuals with ADRD had significantly higher health care usage for both groups except for ICU admissions (stage I-III -0.07 [-0.12, -0.03]; Stage IV -0.03 [-0.07, -0.02]).

Conclusions

Our results suggest that individuals with ADRD diagnosed with both early stage and later stage NSCLC receive less cancer treatment in the form of drug therapy. This may be due to clinician bias regarding older adults with ADRD, or reflect caregiver or patient priorities, e.g., quality of life valued over intervention for longer survival. Given that one in three older adults dies with dementia, this is an important area for further research.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Global Brain Health Institute.

Disclosure

All authors have declared no conflicts of interest.