Clinical outcomes and resource utilization after surgical resection with curative intent among patients with non-small cell lung cancer treated with adjuvant therapies in a community oncology setting: A real-world retrospective observational study

Abstract

Aims: Adjuvant chemotherapy has been shown to improve survival in patients with completely resected early-stage non-small cell lung cancer (NSCLC). This study evaluated real-world relapse rates and healthcare resource utilization in patients with stage II-IIIB NSCLC receiving adjuvant therapy in a community oncology setting after complete resection.

Patients and methods: The study included patients with stage II-IIIB NSCLC and complete resection receiving any adjuvant therapy during 06/2008-04/2017 at US Oncology Network clinics, with follow-up through 04/2019. Primary endpoints were rate of relapse, time to relapse (TTR), disease-free survival (DFS), overall survival (OS), and monthly emergency department (ED) visits and hospitalizations before and after relapse.

Results: The study identified 456 patients; median age was 66 years, 50% were male. In patients with relapse (45.2%), median follow-up was 31.7 months and median TTR was 13.7 months. Median DFS in the overall population was 42.9 months. Median OS was 82.4 months in the overall population and shorter in patients with relapse than without relapse (41.6 months vs. not reached, p < 0.0001). Patients with relapse had significantly more monthly ED visits (mean [SD] 0.10 [0.24] vs. 0.03 [0.08], p < 0.0001) and hospitalizations (mean [SD] 0.20 [0.43] vs. 0.05 [0.10], p < 0.0001) following relapse than before relapse.

Conclusions: Patients with stage II-IIIB NSCLC treated with adjuvant therapy after complete resection had high relapse rates, reduced survival, and significantly increased healthcare resource use when relapse occurred. New therapeutic options to reduce relapse rates in patients with early-stage NSCLC could reduce healthcare utilization and costs.

Keywords: NSCLC; recurrence; relapse; survival; utilization.

FIGURE 1

Study attrition. ECOG, Eastern Cooperative Oncology Network; EHR, electronic health record; NSCLC, non‐small cell lung cancer. *91 patients were excluded as not having complete surgical resection (R0)

FIGURE 2

(a) Disease‐free survival from date of complete surgical resection. Disease‐free survival: defined as the interval between the date of surgery and date of physician‐assessed relapse or date of death from any cause. Patients who did not experience relapse or death were censored at the study end date or the last visit date available in the dataset, whichever occurred first. (b) Overall survival from date of complete surgical resection, overall and by relapse status. Survival defined as overall survival was defined as the time interval between the date of surgery until date of death from any cause. Patients who did not experience an event for the respective time‐to‐event analysis were censored at the study end date or the last visit date available in the dataset, whichever occurred first. CI, confidence interval