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Multicenter Study
. 2010 Jun;17(6):1581-8.
doi: 10.1245/s10434-010-0946-y. Epub 2010 Feb 17.

Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity

Selwyn O Rogers Jr  1 , Stacy W Gray, Mary Beth Landrum, Carrie N Klabunde, Katherine L Kahn, Robert H Fletcher, Steven Clauser, Diana Tisnado, William Doucette, Nancy L Keating
Affiliations
Multicenter Study

Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity

Selwyn O Rogers Jr et al. Ann Surg Oncol. 2010 Jun.

Abstract

Background: Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices.

Methods: We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations.

Results: Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations.

Conclusions: Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.

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Figures

FIG. 1
FIG. 1
Surgeons’ likelihood of recommending lobectomy for early-stage non-small-cell lung cancer by patient age and severity of chronic obstructive pulmonary disease
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