Since December 2013, the US Preventive Services Task Force has recommended lung cancer screening for adults at high risk of developing lung cancer because of their age and smoking history. Increased uptake in lung cancer screening may be reflected in changes in the stage at which lung cancer is diagnosed. To examine the percentage of lung cancer cases diagnosed at an early stage, visualizing temporal patterns with heat maps. This descriptive surveillance study used US Cancer Statistics incidence data to identify US adults who were diagnosed with malignant lung cancer from 2003 to 2022. Data were analyzed from November 14 to November 30, 2025. Percentage of lung cancers diagnosed at early stage, stratified by year of diagnosis, age at diagnosis, and state of residence. From 2003 to 2022, 4 363 687 new lung cancer cases were reported in the US. The percentage diagnosed at early stage increased slowly from 17.6% (95% CI, 17.5%-17.8%) in 2003 to 20.2% (95% CI, 20.0%-20.4%) in 2014, increased sharply from 21.4% (95% CI, 21.2%-21.6%) in 2015 to 24.6% (95% CI, 24.4%-24.8%) in 2016, then increased steadily to 30.1% (95% CI, 29.9%-30.3%) in 2022. The percentage diagnosed at early stage increased in all states, beginning around 2016 in most states. In 2003, the percentage diagnosed at early stage ranged from 11.2% (95% CI, 8.5%-14.6%) to 24.0% (95% CI, 22.7%-25.4%); by 2022, this range was 22.0% (95% CI, 18.9%-25.5%) to 40.2% (95% CI, 36.7%-43.9%). This descriptive surveillance study showed that since lung cancer screening was recommended in 2013, more people with lung cancer are being diagnosed early, when treatment is more effective and more treatment options are available. Population-based survey data indicate that fewer than 1 in 5 eligible persons reported being up to date with lung cancer screening in 2024. Strengthening awareness about the benefits of lung cancer screening and supporting uptake remain important strategies for cancer prevention and control.

Metastatic non-small cell lung cancer (mNSCLC) has very high mortality rates, and comprises approximately half of new cases of lung cancer; however, highly effective and better tolerated treatments have become available in recent decades. Nevertheless, population-level treatment of mNSCLC is poorly characterized in the era of rapid treatment advances. To characterize treatment rates, trends, and factors associated with treatment of mNSCLC. This population-based study used linked Surveillance Epidemiology and End Results (SEER) and Medicare claims data and the analysis included patients 65 years and older diagnosed with mNSCLC from January 2006 to December 2021. Data were analyzed from October 2025 to February 2026. Sociodemographic variables, comorbidity burden, histologic type, referral to subspecialist, enrollment in Medicare Part D, and biomarker testing. The primary outcome was receipt of systemic treatment. Statistical analyses included summary statistics and a competing risk proportional hazards model for receipt of systemic treatment. Of 254 611 patients with mNSCLC, the cohort median (IQR) age was 73 (68-80) years, with 133 635 (52.5%) male individuals; a total of 9512 (3.7%) were Asian, 26 546 (10.4%) were Black, 4553 (1.8%) were Hispanic, 205 381 (80.7%) were White, and 8619 (3.4%) were another or unknown race. A total of 119 197 patients (46.8%) ever received systemic treatment. Of the 100 367 (39.8%) who died within 90 days of diagnosis, 13.2% were treated compared with 69% of those surviving more than 90 days. The treated proportion increased only slightly between 2006 and 2021. In a competing risk model, referral to oncology specialists was associated with treatment (hazard ratio [HR], 2.5; 95% CI, 2.41-2.67; P < .001) which corresponded to a 30.3% greater cumulative incidence of treatment at 180 days (CIF180) compared with those without a referral. Similarly, those with biomarker testing had a 17.8% greater CIF180, whereas those older than 80 years had a 15.4% lower CIF180 compared to those aged 65 to 69 years. Patients with NSCLC not otherwise specified histologic findings had a 12.8% lower CIF180 compared with those with adenocarcinoma histologic findings. Other factors associated with significant but smaller differences in receipt of treatment included comorbidity burden, marital status, Medicare Part C or Part D coverage, rurality, and race and ethnicity. In this cohort study of older adults with mNSCLC, despite advances in therapy in recent decades, almost half of patients never received systemic therapy, and the proportion treated only minimally improved over time. Approximately one-fifth of those with the most favorable clinical profiles did not receive systemic therapy.

The optimal sequencing of radiotherapy (RT) combined with immunotherapy (iRT) and the value of chemotherapy remain undefined for advanced non-small cell lung cancer (NSCLC), where randomized data are limited. To compare real-world overall survival (OS) between sequential and concurrent iRT in newly diagnosed advanced NSCLC, assess the effect of immune checkpoint inhibitor (ICI) maintenance after RT in refractory disease, and evaluate the association of chemotherapy with survival. This is a territory-wide study (OCEANUS) based on the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System (more than 90% population coverage). Patients with NSCLC diagnosed from January 1, 2010, to December 31, 2021, who subsequently received iRT for advanced or refractory disease were included. Overlap weighting was the primary propensity score-weighted method, with inverse probability of treatment weighting used for sensitivity analysis. Data were analyzed from December 2024 to April 2025. Sequential vs concurrent iRT for newly diagnosed advanced NSCLC; RT with vs without ICI maintenance for refractory NSCLC; receipt of chemotherapy. The primary outcome was real-world OS after landmark, estimated with weighted Kaplan-Meier and Cox models. When proportional hazards were violated (per Schoenfeld residuals), treatment effects were summarized using restricted mean survival time. Of 3522 patients who received ICIs, 335 received RT, including 155 with newly diagnosed advanced and 180 with refractory NSCLC. Of these, 247 (73.7%) were male, and the median (range) age was 64 (34-90) years. In newly diagnosed NSCLC, patients treated with sequential iRT had significant longer real-world OS than those treated with concurrent iRT (median, 20.3 months [95% CI, 13.3 to not reached] vs 16.0 months [95% CI, 8.3-30.0]; adjusted hazard ratio, 0.68; 95% CI, 0.47-0.99; P = .045). Chemotherapy was also associated with longer survival in patients with newly diagnosed advanced NSCLC. In refractory NSCLC, RT with ICI maintenance was associated with a numerically longer median real-world OS (11.2 months [95% CI, 7.9-20.6] vs 6.7 months [95% CI, 4.4-17.4]; P = .20). Addition of chemotherapy was not significant for real-world OS. Inverse probability of treatment weighting analyses produced similar estimates. In this cohort study, sequential iRT was associated with longer survival than concurrent iRT in patients with newly diagnosed advanced NSCLC, and chemotherapy was associated with longer survival. In patients with refractory NSCLC who survived at least 90 days, RT with ICI maintenance resulted in nonsignificantly longer survival and an unclear association with chemotherapy. These findings are hypothesis generating and support prospective randomized studies to define optimal sequencing of iRT and use of systemic treatment partners.

This nonrandomized clinical trial examines the safety and efficacy of oral upadacitinib in the treatment of patients with severe immune checkpoint inhibitor–related dermatitis.

This Viewpoint discusses discordance in code status decisions between clinicians and patients with end-stage cancer and provides ethical frameworks for its resolution.