Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer

Abstract

Background: The authors assessed patterns of perioperative chemotherapy use in elderly patients with resected stage I, II, or IIIA nonsmall cell lung cancer (NSCLC) from 1992 to 2002.

Methods: By using data from the Surveillance, Epidemiology, and End Results Program, 11,807 patients were identified who had resected stage I, II, or IIIA NSCLC between 1992 and 2002 and survived >or=120 days beyond diagnosis. The rate of perioperative chemotherapy use was measured by calendar year, and the association between clinical/demographic characteristics and the receipt of chemotherapy was examined by using logistic regression.

Results: In total, 957 patients with stage I, II, or IIIA NSCLC (8.1% of the study population) received perioperative chemotherapy. The proportion of patients receiving chemotherapy for stage I NSCLC changed little during the study period. Of 3230 patients with stage II and IIIA NSCLC, 609 patients (18.9%) received chemotherapy, 423 patients (13%) received chemotherapy combined with radiation. 452 patients (15.6%) received adjuvant chemotherapy, and 66 patients (2.3%) received neoadjuvant chemotherapy. The use of chemotherapy increased significantly among patients who were diagnosed after 1994 relative to patients who were diagnosed in 1992 after controlling for sociodemographic and treatment characteristics (P< .001). There was significantly increased use of new-generation chemotherapy agents, such as carboplatin and taxanes (P< .001). The proportion of patients receiving combined-modality therapy also increased significant (P< .001). Younger age, being married, having advanced-stage tumor or adenocarcinoma, having a later diagnosis year, receiving radiation, and seeing an oncologist were predictors for the receipt of chemotherapy (P< .001).

Conclusions: A substantial proportion of Medicare beneficiaries with NSCLC received perioperative chemotherapy. Specifically designed prospective trials that focus on older patients are needed.

FIGURE 1

Time trends in Medicare claims for perioperative chemotherapy by stage during the period from 1992 to 2002. AJCC indicates American Joint Committee on Cancer.

FIGURE 2

Time trends in Medicare claims for perioperative chemotherapy or combined-modality therapy during the period from 1992 to 2002.

FIGURE 3

Time trends in Medicare claims for specific chemotherapeutic agents for resected stage II, IIIA nonsmall cell lung cancer during the period from 1992 to 2002.