Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery

Salazar, Michelle C.; Rosen, Joshua E.; Wang, Zuoheng; Arnold, Brian N.; Thomas, Daniel C.; Herbst, Roy S.; Kim, Anthony W.; Detterbeck, Frank C.; Blasberg, Justin D.

doi:10.1001/jamaoncol.2016.5829

Cited by 156 publications

(132 citation statements)

References 39 publications

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“…We have further developed and confirmed a survival advantage arising in adenocarcinoma over time and shown a trend toward significance in treatment of adenocarcinoma at ACs versus at CCs. More generally, whereas other studies have highlighted differences between ACs and CCs, 14,[16][17][18][19]28,29 ours is the first to do so across metastatic NSCLC rather than in subgroups of lower-stage malignancy. Quality control was central to our analysis.…”

Section: Discussionmentioning

confidence: 75%

“…10 Other groups have shown increasing survival in all stages of NSCLC over time across periods spanning the 1980s to the 2000s 11,27 ; however, these studies were limited by their lack of multivariable analyses to control for confounding factors that could have changed over time. These studies also did not conduct analyses based on type of treatment facility, which have largely been limited in the literature to analyses of practice patterns 14,[17][18][19]28 and outcomes in focused subgroups of care 16,17,19,29 rather than across an entire category of NSCLC as we have done in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Predominantly, this includes studies of outcomes in surgery and radiation therapy, 15,16 as well as chemotherapy in the adjuvant/neodjuvant setting. [17][18][19]…”

Section: Data Set and Study Populationmentioning

confidence: 99%

“…A growing body of literature in NSCLC has shown that treatment choices and outcomes in localized NSCLC vary between academic centers (ACs) and community-based centers (CCs). 14,[15][16][17][18][19] We hypothesized that ACs may have more availability of lung cancer-specific pathologists and availability for molecular testing to manage the growing complexity of systemic therapies for metastatic NSCLC; that this would be manifested as a growing difference in 2-year survival rates between ACs and CC; and that if survival differences exist, there could be disparities of care accounting for these differences.…”

Section: Introductionmentioning

confidence: 99%

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Survival Comparison in Patients with Stage IV Lung Cancer in Academic versus Community Centers in the United States

Ramalingam

Dinan

Crawford

2018

Journal of Thoracic Oncology

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Introduction: Although metastatic NSCLC is widely treated in both academic centers (ACs) and community-based centers (CCs), it is unclear whether outcomes are similar across both settings. A growing variety of chemotherapies and targeted agents for an increasingly histology-and molecularbased treatment strategy could provide an advantage to patients treated in ACs. Using the National Cancer Database, we investigated whether treatment at ACs was associated with a survival advantage in metastatic NSCLC. Methods:We conducted a retrospective analysis of the National Cancer Database after the introduction of novel NSCLC chemotherapy agents from 1998 to 2010. The primary outcome was 2-year survival, which was analyzed by using a multivariable regression model controlling for age, year of diagnosis, sex, primary payer, histologic type, facility type (AC versus CC), and an interaction term allowing a time-based comparison of survival between ACs and CCs. Alpha was set to 0.001 because of the size of the data set.Results: There were 193,279 patients included in this study. The percentage of patients achieving 2-year survival was higher in ACs versus in CCs in 1998 (11.5% versus 9.2% [þ2.3%]), and by 2010, the difference had increased to 17.4% versus 13.1% (þ4.3%). Multivariable analysis confirmed a significant relative increase in 2-year survival associated with ACs versus with CCs from 1998 to 2010 (p ¼ 0.0005). A histology-dependent survival difference was also noted in adenocarcinoma versus in squamous cell carcinoma (10.2% versus 9.9% in 1998 [þ0.3%], increasing to 17.3% versus 10.1% in 2010 [þ7.2%]). Adenocarcinoma survival also varied by treatment facility, with the difference in 2-year survival in ACs versus in CCs increasing from 12.3% versus 9.1% (þ3.2%) in 1998 to 20.5% versus 15.5% (þ5%) in 2010, with a trend toward significance in our multivariable model (p ¼ 0.005).Conclusions: A greater increase in survival was noted in ACs than in CCs over this time period, and it was particularly pronounced among patients with adenocarcinoma versus in those with squamous cell carcinoma. Given the known advances in adenocarcinoma treatment compared with in squamous cell lung cancer over this time period, our study suggests that potential treatment-related disparities may exist between ACs and CCs. Further study will be needed to validate this disparity in health care and address opportunities to improve survival in patients with stage IV NSCLC across treatment settings.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

“…Predominantly, this includes studies of outcomes in surgery and radiation therapy, 15,16 as well as chemotherapy in the adjuvant/neodjuvant setting. [17][18][19]…”

Section: Data Set and Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival Comparison in Patients with Stage IV Lung Cancer in Academic versus Community Centers in the United States

Ramalingam

Dinan

Crawford

2018

Journal of Thoracic Oncology

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“…4 This suggests that future clinical trials of adjuvant chemotherapy should extend their current timing criteria from 12 weeks to 18 weeks. By allowing this simple extension, more patients, including the elderly (who may need more time to recover), can be enrolled onto trials.…”

mentioning

confidence: 99%

The Ever-Increasing Number of Trial Eligibility Criteria: Time to Bend the Curve

Bradley

Kelly

Stinchcombe

2017

Journal of Thoracic Oncology

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Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

et al. 2019

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Key Points Question Is the timing of adjuvant therapy in resected pancreatic cancer associated with better survival? Findings This cohort study of 7548 patients with stage I to II pancreatic cancer in the National Cancer Database suggested improved survival when adjuvant therapy was initiated 28 to 59 days after surgery. Patients who recovered slowly from surgery still benefited from delayed adjuvant therapy initiated more than 12 weeks after the procedure compared with patients who received surgery alone. Meaning Shared decision-making between clinicians and patients is needed to individualize when to initiate adjuvant therapy based on patients’ postoperative recovery.

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Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery

Cited by 156 publications

References 39 publications

Survival Comparison in Patients with Stage IV Lung Cancer in Academic versus Community Centers in the United States

Survival Comparison in Patients with Stage IV Lung Cancer in Academic versus Community Centers in the United States

The Ever-Increasing Number of Trial Eligibility Criteria: Time to Bend the Curve

Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

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