Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

Abstract

Purpose Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions. MethodsWe retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined.Results During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; p < 0.001).Conclusions Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer.

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

“…In our study, as patient comorbidity score increased, the likelihood of receiving treatment decreased. This is consistent with other studies that showed that patients with higher comorbidity burden are less likely to receive systemic treatment (20,52,53).…”

Wait Times for Diagnosis and Treatment of Lung Cancer: A Single-Centre Experience

“…Comparably, earlier studies have reported that up to 32% of patients with metastatic non-small-cell lung cancer could not receive treatment because of rapidly deteriorating ps 24 and had hypothesized that efficient work-up could lead to increased uptake of treatment 25 .…”

Low lamin A expression in lung adenocarcinoma cells from pleural effusions is a pejorative factor associated with high number of metastatic sites and poor Performance status

“…It is proposed as the most established factor for assessing prognosis and is advised in guidelines for lung cancer treatment [ 64 , 65 ]. Indeed, the Performance status represents a major criteria for treatment decision in advanced lung cancer as patients with a poor Performance status are expected to be unfit for conventional treatments [ 64 – 66 ].…”