Real-world Treatment Patterns Among Patients with Unresected Stage III Non-Small-Cell Lung Cancer

Ryan, Kellie; Skinner, Karen E; Fernandes, Ancilla W.; Punekar, Rajeshwari; Pavilack, Melissa; Walker, Mark S.; VanderWalde, Noam A.

doi:10.2217/fon-2018-0939

Cited by 26 publications

(20 citation statements)

References 17 publications

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“…Our real-world data can also be compared with those from other recent real-world studies. [20][21][22][23] All studies were similar in terms of median age (around 65 years), good PS (75-86%), never-smokers (4-9%) and percentage of adenocarcinomas (around 40%). In comparison to our study, the proportion of females were slightly higher in the American study (44.8%) and the Canadian study (46%).…”

Section: Discussionmentioning

confidence: 70%

“…The concurrent approach was chosen only in 27% of these patients. This low frequency compared to other studies 21,22 may be explained by patients unfit for the concurrent approach, limitations in the infrastructure of several centres including long waiting lists, and a stricter definition of concurrent versus sequential chemoradiotherapy than in other studies.…”

Section: Discussionmentioning

confidence: 72%

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Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience

Zemanová

Pirker

Petruželka

et al. 2020

Radiology and Oncology

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BackgroundManagement of non-small-cell lung cancer (NSCLC) is affected by regional specificities. The present study aimed at determining diagnostic and therapeutic procedures including outcome of patients with NSCLC stage III in the real-world setting in Central European countries to define areas for improvements.Patients and methodsThis multicentre, prospective and non-interventional study collected data of patients with NSCLC stage III in a web-based registry and analysed them centrally.ResultsBetween March 2014 and March 2017, patients (n=583) with the following characteristics were entered: 32% females, 7% never-smokers; ECOG performance status (PS) 0, 1, 2 and 3 in 25%, 58%, 12% and 5%, respectively; 21% prior weight loss; 53% squamous carcinoma, 38% adenocarcinoma; 10% EGFR mutations. Staging procedures included chest X-ray (97% of patients), chest CT (96%), PET-CT (27%), brain imaging (20%), bronchoscopy (89%), endobronchial ultrasound (EBUS) (13%) and CT-guided biopsy (9%). Stages IIIA/IIIB were diagnosed in 55%/45% of patients, respectively. N2/N3 nodes were diagnosed in 60%/23% and pathologically confirmed in 29% of patients. Most patients (56%) were treated by combined modalities. Surgery plus chemotherapy was administered to 20%, definitive chemoradiotherapy to 34%, chemotherapy only to 26%, radiotherapy only to 12% and best supportive care (BSC) to 5% of patients. Median survival and progression-free survival times were 16.8 (15.3;18.5) and 11.2 (10.2;12.2) months, respectively. Stage IIIA, female gender, no weight loss, pathological mediastinal lymph node verification, surgery and combined modality therapy were associated with longer survival.ConclusionsThe real-world study demonstrated a broad heterogeneity in the management o f stage III NSCLC in Central European countries and suggested to increase the rates of PET-CT imaging, brain imaging and invasive mediastinal staging.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 72%

Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience

Zemanová

Pirker

Petruželka

et al. 2020

Radiology and Oncology

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“…The most common treatment in the second and third progression intervals was chemotherapy without radiation therapy, received by 55.4% (112/202) and 70.1% (68/97) of treated patients, respectively. Complete data regarding treatment patterns for this sample are published elsewhere [20].…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Real-world outcomes in patients with unresected stage III non-small cell lung cancer

et al. 2019

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This study examined real-world clinical outcomes such as progression-free survival (PFS), time to metastasis (TTM), overall survival (OS), and health-related quality of life (HRQOL) in patients with unresected stage III non-small cell lung cancer (NSCLC) treated in the community setting. A retrospective review of medical records extracted from 10 US community oncology practices was conducted. Eligible patients were adults diagnosed with stage III NSCLC from 1/1/2011 to 3/1/2016 without evidence of surgical resection within 6 months after stage III NSCLC diagnosis (index date). PFS, OS, and TTM were assessed from the index date, and were analyzed using Kaplan-Meier and Cox regression analyses. HRQOL was assessed for a subset of patients using a patient-reported measure, the 86-item Patient Care Monitor (PCM). Linear mixed models (LMM) were used to assess the impact of patient characteristics and change in PCM scores associated with progression. Among the sample of 478 patients, median PFS (95% confidence interval) was 10 months (9-11), median OS was 20 months (17-22), and median TTM was 30 months (23-45). Most patients (58.2%) experienced disease progression, which the LMM showed to be associated with significant worsening of physical symptoms and psychological states (p < 0.001). This study documented PFS and OS consistent with published literature. The majority of patients experienced disease progression, which was associated with worsening of HRQOL. These findings highlighted the need for better therapeutic options in patients with unresected stage III NSCLC with potential to improve patient outcomes and HRQOL.

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“…Due to the frequency of onset of NSCLC later in life, our study sample included patients with an average age greater than 60 years, with females constituting about half of the study population, which is consistent with other real-world US outcomes studies that examined patients with NSCLC [39][40][41][42][43][44][45][46][47][48].…”

Section: Principal Findingsmentioning

confidence: 68%

Data Integration to Improve Real-world Health Outcomes Research for Non–Small Cell Lung Cancer in the United States: Descriptive and Qualitative Exploration

et al. 2021

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Background The integration of data from disparate sources could help alleviate data insufficiency in real-world studies and compensate for the inadequacies of single data sources and short-duration, small sample size studies while improving the utility of data for research. Objective This study aims to describe and evaluate a process of integrating data from several complementary sources to conduct health outcomes research in patients with non–small cell lung cancer (NSCLC). The integrated data set is also used to describe patient demographics, clinical characteristics, treatment patterns, and mortality rates. Methods This retrospective cohort study integrated data from 4 sources: administrative claims from the HealthCore Integrated Research Database, clinical data from a Cancer Care Quality Program (CCQP), clinical data from abstracted medical records (MRs), and mortality data from the US Social Security Administration. Patients with lung cancer who initiated second-line (2L) therapy between November 01, 2015, and April 13, 2018, were identified in the claims and CCQP data. Eligible patients were 18 years or older and received atezolizumab, docetaxel, erlotinib, nivolumab, pembrolizumab, pemetrexed, or ramucirumab in the 2L setting. The main analysis cohort included patients with claims data and data from at least one additional data source (CCQP or MR). Patients without integrated data (claims only) were reported separately. Descriptive and univariate statistics were reported. Results Data integration resulted in a main analysis cohort of 2195 patients with NSCLC; 2106 patients had CCQP and 407 patients had MR data. The claims-only cohort included 931 eligible patients. For the main analysis cohort, the mean age was 62.1 (SD 9.27) years, 48.56% (1066/2195) were female, the median length of follow-up was 6.8 months, and for 37.77% (829/2195), death was observed. For the claims-only cohort, the mean age was 66.6 (SD 12.69) years, 52.1% (485/931) were female, the median length of follow-up was 8.6 months, and for 29.3% (273/931), death was observed. The most frequent 2L treatment was immunotherapy (1094/2195, 49.84%), followed by platinum-based regimens (472/2195, 21.50%) and single-agent chemotherapy (441/2195, 20.09%); mean duration of 2L therapy was 5.6 (SD 4.9, median 4) months. We describe challenges and learnings from the data integration process, and the benefits of the integrated data set, which includes a richer set of clinical and outcome data to supplement the utilization metrics available in administrative claims. Conclusions The management of patients with NSCLC requires care from a multidisciplinary team, leading to a lack of a single aggregated data source in real-world settings. The availability of integrated clinical data from MRs, health plan claims, and other sources of clinical care may improve the ability to assess emerging treatments.

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Real-world Treatment Patterns Among Patients with Unresected Stage III Non-Small-Cell Lung Cancer

Cited by 26 publications

References 17 publications

Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience

Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience

Real-world outcomes in patients with unresected stage III non-small cell lung cancer

Data Integration to Improve Real-world Health Outcomes Research for Non–Small Cell Lung Cancer in the United States: Descriptive and Qualitative Exploration

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