Who are the vulnerable lung cancer patients at risk for not receiving first-line curative or palliative treatment?

Rikke Langballe, Jakobsen Erik, Iachina Maria, Karlsen Randi Valbjørn, Ehlers Jeanette Haar, Svendsen Mads Nordahl, Bodtger Uffe, Hilberg Ole, Dalton Susanne Oksbjerg, Bidstrup Pernille Envold

Research output: Contribution to journalJournal articleResearch


Background: To identify non-small-cell lung cancer (NSCLC) patients in need of comprehensive support, we examined the association between patient and disease-related factors of vulnerability related to not receiving guideline-recommended treatment. Material and methods: We identified 14,597 non-small-cell lung cancer (NSCLC) patients with performance status <3 during 2013–2018 in the Danish Lung Cancer Registry. Multivariate logistic regression models were used to estimate Odds Ratios (ORs) and 95% confidence intervals (CIs) for receiving guideline-recommended treatment according to stage, comorbidities, age, performance status, long distance to hospital, cohabitation status, education and alcohol abuse. Results: 21% of stage I-IIIA NSCLC patients did not receive curative treatment while 10% with stage IIIB-IV did not receive any oncological therapy. Factors associated with reduced likelihood of receiving curative treatment included: advanced stage (OR = 0.45; 95% CI = 0.42–0.49), somatic comorbidity (OR = 0.72; 95% CI = 0.63–0.83), age ≥ 80 years (OR = 0.59; 95% CI = 0.55–0.64), performance status = 2 (OR = 0.33; 95% CI = 0.28–0.39) and living alone (OR = 0.79; 95% CI = 0.69–0.90). Results were similar for stage IIIB-IV NSCLC patients, although a statistically significant association was also seen for long distances to the hospital (OR = 0.71; 95% CI = 0.58–0.86). Conclusions: Several factors are associated with not receiving guideline-recommended NSCLC treatment with age, performance status, comorbidity and stage being most predictive of no treatment receipt. Efforts should be made to develop support for vulnerable lung cancer patients to improve adherence to optimal first-line therapy.

Original languageEnglish
JournalActa Oncologica
Issue number10
Pages (from-to)1301-1308
Publication statusPublished - Oct 2023


  • Non-small cell lung cancer
  • curative treatment
  • palliative treatment
  • vulnerability factors
  • Lung Neoplasms/pathology
  • Humans
  • Aged, 80 and over
  • Palliative Care
  • Registries
  • Carcinoma, Non-Small-Cell Lung/pathology
  • Neoplasm Staging


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