Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not

Brule, Stephanie Yasmin; Al-Baimani, Khalid; Jonker, Hannah; Zhang, Tinghua; Nicholas, Garth; Goss, Glenwood D.; Laurie, Scott A.; Wheatley‐Price, Paul

doi:10.1016/j.lungcan.2016.04.007

Cited by 39 publications

(38 citation statements)

References 34 publications

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“…Shortening the diagnostic and treatment delay times might be a difficult task, but it is one that should be attempted by prioritizing access to diagnostic procedures for patients with a presumptive diagnosis of lung cancer. A study similar to ours was recently conducted in Ottawa, and it also reported low rates of treatment administration in patients with advanced nsclc (45% of patients did not receive treatment) 40 . Brule et al 40 refer to a Cancer Assessment Clinic, together with implementation of the Lung Transformation Project, that provides expedited diagnostic procedures and early referral to oncologists and seems to have reduced wait times by approximately 40% during its first 6 months of operation 40 .…”

Section: Discussionsupporting

confidence: 77%

“…A study similar to ours was recently conducted in Ottawa, and it also reported low rates of treatment administration in patients with advanced nsclc (45% of patients did not receive treatment) 40 . Brule et al 40 refer to a Cancer Assessment Clinic, together with implementation of the Lung Transformation Project, that provides expedited diagnostic procedures and early referral to oncologists and seems to have reduced wait times by approximately 40% during its first 6 months of operation 40 . Similar programs could be adopted in other provinces, potentially increasing access to therapeutic interventions.…”

Section: Discussionsupporting

confidence: 77%

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Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 77%

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

et al. 2017

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“…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 .…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2017

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“…Some studies from British Columbia and Ontario suggest that, during a similar period, the proportion of stage iv nsclc patients who received chemotherapy increased to 35%-45% from less than 25% over time 33,34 . One Canadian study reports up to 50% administration of systemic therapy between 2009 and 2012 35 . However, other centres in Canada reported no significant changes in systemic therapy administration, which is similar to the findings in our study 24,36 .…”

Section: Figurementioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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Introduction Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival. Methods ConclusionsOur experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

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Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not

Cited by 39 publications

References 34 publications

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

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

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

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