Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

Abstract

Hypothesis There is limited data on the care and outcomes of individuals with both chronic obstructive pulmonary disease (COPD) and lung cancer, particularly in advanced disease. We hypothesized such patients would receive less cancer treatment and have worse outcomes. Methods We analyzed administrative data from the province of Ontario including demographics, hospitalization records, physician billings, cancer diagnosis, and treatments. COPD was defined using the ICES-derived COPD cohort (1996–2014) with data from 2002 to 2014. Descriptive statistics and multivariable analyses were undertaken. Results Of 105 304 individuals with lung cancer, 43 375 (41%) had stage data and 36 738 (34.9%) had COPD. Those with COPD were likely to be younger, have a Charlson score ≤ 1, have lower income, to live rurally, and to have stage I/II lung cancer (29.8 vs 26.5%; all p<0.001). For the COPD population with stage I/II cancer, surgery and adjuvant chemotherapy were less likely (56.8 vs. 65.9% and 15.4 vs. 17.1%, respectively), while radiation was more likely (26.0 vs. 21.8%) (p all < 0.001). In the stage III/IV population, individuals with COPD received less chemotherapy (55.9 vs 64.4%) or radiation (42.5 vs 47.5%; all p<0.001). Inhaler and oxygen use was higher those with COPD, as were hospitalizations for respiratory infections and COPD exacerbations. On multivariable analysis, overall survival was worse among those with COPD (HR 1.20, 95% CI 1.19–1.22). Conclusions A co-diagnosis of COPD and lung cancer is associated with less curative treatment in early stage disease, less palliative treatment in late stage disease, and poorer outcomes.

The benefits and harms of adjuvant chemotherapy for non-small cell lung cancer in patients with major comorbidities: A simulation study

“…We also found that many patients with COPD benefit from receiving adjuvant chemotherapy. Lung cancer patients with COPD have worse outcomes and are less likely to receive adjuvant therapy (39, 40). Additionally, lung cancer may be more aggressive in patients with COPD (41-43).…”

Characterizing Variability in Lung Cancer Outcomes and Influence of a Lung Diagnostic Assessment Program in Southeastern Ontario, Canada

“…Optimization of comorbid lung disease such as chronic obstructive pulmonary disease (COPD) has been associated with improved perioperative outcomes in patients with early-stage LC [24][25][26]. In fact, one study showed that co-diagnosis of COPD and LC is associated with less curative treatment in early-stage disease, less palliative treatment in advanced-stage disease, and overall worse outcomes [27,28]. Given the benefits of respiratory specialist assessment in LC care, it is possible that the increased likelihood of respiratory specialist management in patients managed through the LDAP had an influential role in contributing to the observed improved survival.…”

Long-Term Outcome of Chronic Obstructive Pulmonary Disease: A Review

“…Overall survival is low in lung cancer patients with COPD (HR, 1.20; 95% CI, 1.19–1.22). Moreover, fewer surgical resections were performed and less adjuvant chemotherapy was administered to stage I or II lung cancer patients with COPD, and less palliative chemotherapy and radiation therapy were performed in stage III or IV lung cancer patients with COPD [ 27 ]. Active treatment for lung cancer might be limited because of the reduced lung function and breathing difficulty in COPD, which in turn leads to a decrease in the survival of lung cancer patients with COPD.…”