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Cancer Research recently ran an article based on an original review published in the journal Oncology that explored reasons why small cell lung cancer (SCLC) patients have refused treatment. Although results appeared obvious, the theme of this article relates to methods of increasing patient survival.

About Small Cell Lung Cancer (SCLC)

The grim five-year survival for patients with SCLC is less than seven percent after diagnosis. SCLC accounts for almost one-quarter of all cancer deaths. Treatments currently include radiotherapy, chemotherapy, surgery, and immunotherapy. Additional information is available here.

About the Study

A team of doctors used data from the National Cancer Database and analyzed 107,988 SCLC patients beginning in 2003 through 2012. Researchers noticed an increase in refusals during this period with refusals coming mostly from ES-SCLC patients.

On average, chemoradiotherapy was refused at a rate of 1.34% among patients with LS-SCLC while ES-SCLC patients refused chemotherapy at a rate of 4.70%.

An analysis that combined the two groups suggested that the female gender, patients over seventy years of age, lack of health insurance, and having other unrelated illnesses were a source of treatment refusals.

Median survival for LS-SCLS patients who refused treatment was three months versus eighteen months for patients who received treatment.

The median survival for ES-SCLS patients after refusing chemotherapy was one month versus seven months for patients who accepted treatment.

Why Age Matters

An older person’s decision to decline treatment is usually based on his or her concern about toxicity and side effects of chemotherapy, the length of treatment, and whether the treatment would be effective. Many older people have other health issues that compound the effect of chemotherapy.

But other studies show that younger and older patients respond equally to a combined modality therapy. For purposes of this discussion, it is a combination of radiotherapy and chemotherapy.

Recent data suggests that when older patients are treated with combined modality therapy, they had improved overall survival compared to patients who received chemotherapy alone.

Looking Forward

SCLC Patients’ refusal for treatment is directly related to a significantly lower rate of survival. Strategies are needed that will improve patient acceptance of their physicians’ recommendations.