TY - JOUR
T1 - Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection
T2 - A nationally representative cohort study
AU - Wong, Melisa L.
AU - McMurry, Timothy L.
AU - Stukenborg, George J.
AU - Francescatti, Amanda B.
AU - Amato-Martz, Carla
AU - Schumacher, Jessica R.
AU - Chang, George J.
AU - Greenberg, Caprice C.
AU - Winchester, David P.
AU - McKellar, Daniel P.
AU - Walter, Louise C.
AU - Kozower, Benjamin D.
N1 - Funding Information:
Timothy L. McMurry has received consulting support from Diffusion Pharmaceuticals. Amanda B. Francescatti has stock ownership in ICAD. George J. Chang has received consulting support from Ethicon. Caprice C. Greenberg has received grant funding from Covidien-Medtronic and consulting support from Johnson and Johnson. The remaining authors have declared no conflicts of interest.
Funding Information:
This work was supported by the Patient-Centered Outcomes Research Institute (PCORI; CE-1306-00727, Kozower), the National Institute on Aging (T32AG000212, Wong and K24AG041180, Walter), and the National Cancer Institute (UG1CA189823, Alliance for Clinical Trials in Oncology NCORP Research Base).
Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Objective Older patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort. Materials and methods We randomly selected 9001 patients with surgically resected stage I–III NSCLC in 2006–2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression. Results Median age at initial diagnosis was 67; 69.7% had >1 comorbidity. At 5-year follow-up, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age >75 compared with <55; 95% CI 0.27–0.88) and those with substance abuse (OR 0.43; 95% CI 0.23–0.81) were less likely to receive active treatment. Women (OR 0.62; 95% CI 0.43–0.89) and patients with symptomatic recurrence (OR 0.69; 95% CI 0.47–0.99) were also less likely to receive active treatment. Among those with distant recurrence, 77.3% received active treatment. Older patients (OR 0.42 for age >75 compared with <55; 95% CI 0.26–0.68) and those with any documented comorbidities (OR 0.59; 95% CI 0.38–0.89) were less likely to receive active treatment. Conclusion Older patients independent of comorbidity, patients with substance abuse, and women were less likely to receive active treatment for postoperative NSCLC recurrence. Studies to further characterize these disparities in treatment of NSCLC recurrence are needed to identify barriers to treatment.
AB - Objective Older patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort. Materials and methods We randomly selected 9001 patients with surgically resected stage I–III NSCLC in 2006–2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression. Results Median age at initial diagnosis was 67; 69.7% had >1 comorbidity. At 5-year follow-up, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age >75 compared with <55; 95% CI 0.27–0.88) and those with substance abuse (OR 0.43; 95% CI 0.23–0.81) were less likely to receive active treatment. Women (OR 0.62; 95% CI 0.43–0.89) and patients with symptomatic recurrence (OR 0.69; 95% CI 0.47–0.99) were also less likely to receive active treatment. Among those with distant recurrence, 77.3% received active treatment. Older patients (OR 0.42 for age >75 compared with <55; 95% CI 0.26–0.68) and those with any documented comorbidities (OR 0.59; 95% CI 0.38–0.89) were less likely to receive active treatment. Conclusion Older patients independent of comorbidity, patients with substance abuse, and women were less likely to receive active treatment for postoperative NSCLC recurrence. Studies to further characterize these disparities in treatment of NSCLC recurrence are needed to identify barriers to treatment.
KW - Geriatric oncology
KW - Non-small cell lung cancer
KW - Recurrence
KW - Treatment
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U2 - 10.1016/j.lungcan.2016.11.002
DO - 10.1016/j.lungcan.2016.11.002
M3 - Article
C2 - 27987578
AN - SCOPUS:84995376640
SN - 0169-5002
VL - 102
SP - 108
EP - 117
JO - Lung Cancer
JF - Lung Cancer
ER -
