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. 2016 Dec:102:108-117.
doi: 10.1016/j.lungcan.2016.11.002. Epub 2016 Nov 9.

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

Melisa L Wong  1 , Timothy L McMurry  2 , George J Stukenborg  3 , Amanda B Francescatti  4 , Carla Amato-Martz  5 , Jessica R Schumacher  6 , George J Chang  7 , Caprice C Greenberg  8 , David P Winchester  9 , Daniel P McKellar  10 , Louise C Walter  11 , Benjamin D Kozower  12
Affiliations

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study

Melisa L Wong et al. Lung Cancer. 2016 Dec.

Abstract

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.

Keywords: Geriatric oncology; Non-small cell lung cancer; Recurrence; Treatment.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Non-small cell lung cancer National Cancer Data Base study flow chart.
Figure 2
Figure 2
Multivariable generalized estimating equation logistic regression models of predictors of active treatment versus supportive care only for a) locoregional recurrence and b) distant recurrence. Model C-statistic for locoregional recurrence is 0.78. Model C-statistic for distant recurrence is 0.75.
Figure 3
Figure 3
Kaplan-Meier post-recurrence survival curves for non-small cell lung cancer patients with a) locoregional recurrence and b) distant recurrence by type of treatment received.
See this image and copyright information in PMC

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