Barriers to Combined-Modality Therapy for Limited-Stage Small Cell Lung Cancer

Pezzi, Todd A.; Schwartz, David L.; Mohamed, A.S.R.; Welsh, James W.; Komaki, Ritsuko; Hahn, Stephen M.; Sepesi, Boris; Pezzi, Christopher M.; Fuller, Clifton D.; Chun, Stephen G.

doi:10.1001/jamaoncol.2017.4504

Cited by 40 publications

(58 citation statements)

References 15 publications

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“…More specifically, patients with nonsquamous NSCLC with Medicaid/other public or no insurance were less likely to receive bevacizumab, whereas patients with Medicaid/other public or military-related insurance were less likely to receive TKIs. Our findings are consistent with studies that have noted that Medicaid and uninsured patients with NSCLC and other cancers are less likely to receive recommended treatments than patients with private insurance (20,(31)(32)(33)(34). Our findings also are consistent with two studies that found fewer patients with NSCLC with public insurance received molecular testing or TKIs compared with patients with private insurance (9,35).…”

Section: Discussionsupporting

confidence: 91%

“…Studies have shown that patients with Medicaid insurance or no insurance are less likely to receive recommended cancer treatments than patients with private insurance (16)(17)(18). Compared to patients with private insurance, patients with lung cancer with no insurance or public insurance have higher mortality, more treatment delays, and are less likely to receive molecular testing, chemotherapy, or radiation (9,(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

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Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear.Methods: Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields.Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments.Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts.Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Although some patients may prefer to undergo a complex surgical procedure at a local LVH, 41 there is concern that socioeconomic barriers may prevent many patients from accessing care at HVHs and specialized referral centers. 20,42,43 In the current study, demographic data available in the NCDB suggest that patients who underwent surgery at LVHs may be of lower socioeconomic status, raising concerns that socioeconomic circumstances may be barriers to a patient's ability to access care at HVHs for the treatment of RPS.…”

Section: Total Number Of Primary Rps Surgical Resections Versus % Of mentioning

confidence: 81%

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Keung

Chiang

Cormier

et al. 2018

Cancer

111

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Background Retroperitoneal sarcomas (RPS) are rare tumors for which complete surgical resection remains the mainstay of treatment. We sought to determine the impact of hospital case volume on RPS outcomes. Methods We identified 6950 patients with primary RPS who underwent surgical resection from the National Cancer Data Base (1998–2011). Treating hospitals were classified by annual case volume; low volume hospitals (LVHs) and high volume hospitals (HVHs) were defined as ≤10 and >10 cases/year, respectively. Overall survival (OS) was compared using Kaplan-Meier curves. Cox proportional hazard models were created to compare risks. Results Of 1131 reporting hospitals, most (n=1127, 99.6%) were LVHs treating the majority of patients (n=6270; 90.2%). Patients treated at LVHs were more likely to have lower grade and smaller tumors, receive radiation therapy, and undergo incomplete gross (R2) resection. Patients treated at HVHs had lower 30-day readmission rates (1.8% vs 3.4%, p<0.001), 30-day (1.9% vs 3.1%, p=0.004) and 90-day mortality (3.2% vs 5.7%, p=0.007); longer median OS (76.2 vs 64.2 months, p<0.001) and higher 5-year OS (58% vs 52%, p<0.001). After controlling for age, gender, insurance status, tumor size, tumor grade, resection margin status, and radiation administration, treatment at a HVH was independently associated with a reduced risk of death (HR 0.77, 95% CI 0.65–0.91, p=0.003). Conclusion Primary RPS are rare tumors for which few surgeons and institutions have significant experience and expertise in their multidisciplinary management and surgical resection. Although additional studies are needed, patient outcomes may be impacted by treating facility case volume and experience.

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“…In the real world, the treatment plan depended on several factors, such as patients' and physicians' discretions, patients' ECOG performance status, and waiting time to receive each treatment. For instance, in the United States, only 55% of patients with LS received combined-modality therapy, which was limited by the health insurance system, resulting in poorer survival [16].…”

Section: Discussionmentioning

confidence: 99%

“…Median survival time (MST) of SCLC patients in Phase III trials with LS and ES was 17 to 30 months and 7.1 to 12.8 months, respectively [6]- [14]. In the real world, previous reports revealed that the survival of SCLC patients with LS and ES was 10.3 to 18.2 months and 5.5 to 10.2 months, respectively [15] [16] [17].…”

Section: Introductionmentioning

confidence: 99%

Survival of Patients with Small-Cell Lung Cancer Treated at Tertiary Hospitals in the East of Thailand, 2007-2016: A Retrospective Study

Sukauichai¹,

Tovanabutra²,

Tangchewinsirikul³

et al. 2019

ALC

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Objective: The objective of the study was to determine the survival of patients with small-cell lung cancer treated at tertiary hospitals in the East of Thailand. Materials and methods: The researchers conducted this retrospective study by reviewing medical records of patients with small-cell lung cancer treated at Chonburi Cancer Hospital and Prapokklao Hospital from January 2007 to December 2016 and monitored via follow-up until December 2018. Results: This study enrolled 54 patients with a median follow-up time of 8.5 months. The median age of patients was 63 years old. Most patients were male (83.3%) and had a history of smoking (90.7%), and 31.4% had clinical superior vena cava obstruction at initial treatment. The Eastern Cooperative Oncology Group performance status 0-1 was noted for 61.1% of the study population. Median survival time of patients with limited-stage and extensive-stage small cell lung cancer who received systemic chemotherapy and/or radiotherapy was 17.01 months (95% CI, 12.01 -22.01) and 8.14 months (95% CI, 7.19 -9.10), respectively, and that of patients receiving supportive care was 2.3 months (95% CI, 0.75 -4.03). However, the median survival time of patients with extensive-stage small-cell lung cancer receiving only palliative chemotherapy was 5.9 months (95% CI, 0.32 -17.51). Conclusions: The median survival time of patients with limited-stage small-cell lung cancer treated in the East of Thailand was comparable to those of landmark studies; however, the survival of patients with extensive-stage small-cell lung cancer was shorter than those of Phase III trials. A multidisciplinary team was necessary to improve the quality of patient care.

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Barriers to Combined-Modality Therapy for Limited-Stage Small Cell Lung Cancer

Cited by 40 publications

References 15 publications

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Survival of Patients with Small-Cell Lung Cancer Treated at Tertiary Hospitals in the East of Thailand, 2007-2016: A Retrospective Study

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