Influence of Medical Comorbidities on the Presentation and Outcomes of Stage I-III Non–Small-Cell Lung Cancer

Abstract

Background Non-small cell lung cancer (NSCLC) presentation, treatment, and outcomes vary widely according to socioeconomic factors and other patient characteristics. To determine whether medical comorbidities account for these observations, we incorporated a validated medical comorbidity index into an analysis of patients diagnosed with stage I–III NSCLC. Patients and Methods We performed a retrospective analysis of consecutive patients diagnosed with stage I–III NSCLC. Demographic, tumor, and comorbidity data were obtained from hospital tumor registries and individual patient records. The association between variables was assessed through multivariate logistic regression and survival analysis. Results A total of 454 patients met criteria for analysis. Median age was 65 years, and 51% were men. Individuals with a higher Charlson Comorbidity Index (CCI) were significantly more likely to present with early stage (stage I–II) NSCLC than were patients with lower CCI (OR 1.72; 95% CI, 1.14 to 2.63; P=0.01), although this association lost statistical significance (P=0.21) in a multivariate model. In multivariate logistic regression, overall survival remained associated with all variables: age, gender, race, insurance type, stage, histology, and CCI (P=0.0007). The CCI was associated with survival for patients with both early stage (P=0.02) and locally advanced (P=0.02) disease. Conclusions In this cohort of patients with stage I–III NSCLC, increasing comorbidity burden had a non-significant association with diagnosis at earlier disease stage. Although comorbidity burden was significantly associated with outcome for both early stage and locally advanced disease, it did not account for survival differences based on multiple other patient and disease characteristics.

Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

“…Another possibility is leadtime bias: Although all cases in this study were stage IV, those occurring after a prior cancer may have been diagnosed earlier in the disease course because of more frequent and intensive clinical care related to the prior cancer. This hypothesis echoes earlier findings that increased comorbidity burden is associated with lung cancer diagnosis at an earlier stage (33).…”

“…We examined multiple SEER covariables associated with lung cancer prognosis as endorsed by earlier studies (33). For a full account of these covariables see the Supplementary Methods (available online).…”

“…Compared with other common exclusion criteria, prior cancer may be one of the most substantial factors limiting accrual. In a recent study of medical comorbidities among 460 patients with lung cancer, the proportion of patients with prior cancer was three times the proportion with renal disease, seven times the proportion with liver disease, and 14 times the proportion with human immunodeficiency virus (33). Furthermore, the observation that the majority of prior cancer cases are diagnosed within five years of the lung cancer diagnosis suggests that the common practice of excluding prior cancer within five years of enrollment still results in exclusion of a substantial proportion of patients (20).…”

Prior cancer does not adversely affect survival in locally advanced lung cancer: A national SEER-medicare analysis

“…We examined multiple covariates previously shown to be associated with lung cancer prognosis [19, 25]. Surgery within 120 days of diagnosis, chemotherapy within 120 days of diagnosis, and radiotherapy within one year of diagnosis were identified using Medicare inpatient, outpatient, and physician claims (coded yes/no) [26].…”

Impact of Accompanying Comorbidities on Survival in Patients with Stage IIIB- IV Non-Small-Cell Lung Cancer

“…It is not clear to what extent these comorbid conditions affect treatment selection and patient overall survival. 43 From the results of our study and in conclusion, we can say that the existence of comorbid factors have a negative effect on survival durations while increasing the risk of therapy-related toxicities. The patient's age alone does not have a significant effect on survival duration, and toxicity rates.…”