OBJECTIVES : To estimate the real-world prevalence of small cell lung cancer (SCLC), map the treatment journey, and quantify healthcare resource utilization (HCRU) associated with myelosuppression, a complication of SCLC treatment, induced by chemotherapy or chemotherapy plus radiotherapy.

METHODS : This was a retrospective study of patients with SCLC aged ≥65 years, identified from linked Surveillance, Epidemiology, and End Results and Medicare (SEER-Medicare) data curated between January 2005 and December 2015. Chemotherapy use was identified and classified as first, second, or third line, depending on the temporal sequence in which regimens were prescribed. Across the years 2012–2015, proportions of patients completing 4- or 6-cycle chemotherapy regimens, and proportions of patients who had hospital admissions associated with myelosuppression, or who used granulocyte colony-stimulating factors (G-CSF), blood or platelet transfusions, or erythropoiesis-stimulating agents (ESAs) were calculated.

RESULTS : SCLC prevalence peaked in 2009 and declined thereafter. Prevalence was highest among white patients, male patients, and those in their seventies. Chemotherapy was administered as first- or second-line treatment in 77.4% and 22.1% of cases, respectively. Among patients who received first-line chemotherapy, and for whom a second treatment was recorded, radiotherapy was administered in 98.4% of cases. Across 2012–2015, 57.8% of patients completed the guideline-recommended 4–6 cycles of chemotherapy. During the same period, among all patients treated with chemotherapy, 74.3% experienced ≥1 inpatient admission associated with myelosuppression (anemia, 52.8%; neutropenia, 33.3%; thrombocytopenia, 17.0%; pancytopenia, 14.2%). HCRU included rescue interventions with G-CSF in 48.4% of patients, ESAs in 11.0% of patients, and transfusions in 26.3% of patients.

CONCLUSIONS : Chemotherapy remains a cornerstone of care for patients with SCLC. Slightly over half of patients from the SEER-Medicare databases completed the recommended number of cycles. HCRU associated with myelosuppression was prominent across all study years, suggesting that myelosuppression imposes a substantial burden on elderly patients with SCLC.