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

Wong, Melisa L.; McMurry, Timothy L.; Stukenborg, George J.; Francescatti, Amanda B.; Amato-Martz, Carla; Schumacher, Jessica R.; Chang, George J.; Greenberg, Caprice C.; Winchester, David P.; McKellar, Daniel P.; Walter, Louise C.; Kozower, Benjamin D.

doi:10.1016/j.lungcan.2016.11.002

Cited by 46 publications

(47 citation statements)

References 41 publications

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“…The age disparity that remains even after correcting for comorbidity level, however, does raise the question of whether older patients have lower access to genetic testing not because they are sicker, but simply because they are older. Comorbidity-independent age-based disparity has already been documented in the more general context of active treatment for NSCLC (42)(43)(44), and our result implies that this disparity may also exist in targeted therapy treatment specifically. Further investigation is warranted to determine whether this disparity could be due to patient preferences or to inappropriate undertreatment.…”

Section: Discussionsupporting

confidence: 70%

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Palazzo

Sheehan

Tramontano

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Despite reports of socioeconomic disparities in rates of genetic testing and targeted therapy treatment for metastatic non-small cell lung cancer (NSCLC), little is known about whether such disparities are changing over time.Methods: We performed a retrospective analysis to identify disparities and trends in genetic testing and treatment with erlotinib. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 9,900 patients with stage IV NSCLC diagnosed in 2007 to 2011 at age 65 or older. We performed logistic regression analyses to identify patient factors associated with odds of receiving a genetic test and erlotinib treatment, and to assess trends in these differences with respect to diagnosis year.Results: Patients were more likely to receive genetic testing if they were under age 75 at diagnosis [odds ratio (OR), 1.55] independent of comorbidity level, and this age-based gap showed a decrease over time (OR, 0.93). For untested patients, erlotinib treatment was associated with race (OR, 0.58, black vs. white; OR, 2.45, Asian vs. white), and was more likely among female patients (OR, 1.45); for tested patients, erlotinib treatment was less likely among low-income patients (OR, 0.32). Most of these associations persisted or increased in magnitude.Conclusions: Race and sex are associated with rates of erlotinib treatment for patients who did not receive genetic testing, and low-income status is associated with treatment rates for those who did receive testing. The racial disparity remained stable over time, while the income-based disparity grew larger.Impact: Attention to reducing disparities is needed as precision cancer treatments continue to be developed.

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Section: Discussionsupporting

confidence: 70%

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Palazzo

Sheehan

Tramontano

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Otherwise, in a study of early NSCLC, Masaki et al [23] reported that patients with early-stage peripheral NSCLC were more likely to have distant failure. In a study by Melisa et al [24], their data indicated that the recurrence rate of distant sites was higher than that at local sites in younger patients with NSCLC and peripheral NSCLC. Although the populations were different between our cohort and the above two studies, we obtained similar predictors for the first failure pattern for NSCLC patients.…”

Section: Discussionmentioning

confidence: 96%

Predictive model of the first failure pattern in patients receiving definitive chemoradiotherapy for inoperable locally advanced non-small cell lung cancer (LA-NSCLC)

Zhu

Hou

et al. 2020

Radiat Oncol

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Purpose: To analyze patterns of failure in patients with LA-NSCLC who received definitive chemoradiotherapy (CRT) and to build a nomogram for predicting the failure patterns in this population of patients. Materials and methods: Clinicopathological data of patients with LA-NSCLC who received definitive chemoradiotherapy and follow-up between 2013 and 2016 in our hospital were collected. The endpoint was the first failure after definitive chemoradiotherapy. With using elastic net regression and 5-fold nested cross-validation, the optimal model with better generalization ability was selected. Based on the selected model and corresponding features, a nomogram prediction model was built. This model was also validated by ROC curves, calibration curve and decision curve analysis (DCA). Results: With a median follow-up of 28 months, 100 patients experienced failure. There were 46 and 54 patients who experience local failure and distant failure, respectively. Predictive model including 9 factors (smoking, pathology, location, EGFR mutation, age, tumor diameter, clinical N stage, consolidation chemotherapy and radiation dose) was finally built with the best performance. The average area under the ROC curve (AUC) with 5fold nested cross-validation was 0.719, which was better than any factors alone. The calibration curve revealed a satisfactory consistency between the predicted distant failure rates and the actual observations. DCA showed most of the threshold probabilities in this model were with good net benefits. Conclusion: Clinicopathological factors could collaboratively predict failure patterns in patients with LA-NSCLC who are receiving definitive chemoradiotherapy. A nomogram was built and validated based on these factors, showing a potential predictive value in clinical practice.

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“…Cancer patients with comorbid conditions are generally less likely to receive surgery or other curative treatment. The increased risk of treatment toxicity, side effects and post-operative complications associated with comorbidity or the concern that the life expectancy of patients with comorbidity is insufficient to justify the use of potentially toxic therapy may prevent clinicians from aggressive treatment choices [30]. Additionally, there was a lack of high-level evidence on the effect of cancer therapies among patients with comorbidity since most of randomized controlled trials always exclude those with concomitant conditions.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China

Ding

Zhu

et al. 2020

BMC Cancer

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Background: It is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China. Methods: We used claims data from China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively. Results: Among 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI: 1.012-1.441) and chemotherapy (1.363, 1.196-1.554), and decreased possibility of choosing surgery (0.850, 0.730-0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions. Conclusion: Comorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.

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

Cited by 46 publications

References 41 publications

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non–Small Cell Lung Cancer Patients

Predictive model of the first failure pattern in patients receiving definitive chemoradiotherapy for inoperable locally advanced non-small cell lung cancer (LA-NSCLC)

Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China

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