Why Do Some Lung Cancer Patients Receive No Anticancer Treatment?

Vinod, Shalini; Sidhom, Mark; Gabriel, Gabriel; Lee, Mark T; Delaney, Geoff P.

doi:10.1097/jto.0b013e3181da85e4

Cited by 55 publications

(53 citation statements)

References 31 publications

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“…These figures varies from 19% in USA, 33% in Australia, 37% in Scotland, and 50% in Ireland and New Zealand (Fry et al, 1999;Vinod et al, 2008;Erridge et al, 2008;Mahmud et al, 2003;Stevens et al, 2007). Vinod et al (2010) have addressed this issue in their study and found that in actual practice 20% patients didn't receive any treatment; however guideline recommendations for no treatment were there in only 4% patients. On multivariate analysis, it was observed that main factors responsible for this discrepancy were older age, poor PS, NSCLC histology and social reasons.…”

Section: Discussionmentioning

confidence: 99%

Clinico-pathological Profile of Lung Cancer at AIIMS: A Changing Paradigm in India

Malik¹,

Sharma²,

Mohanti³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Lung cancer is one of the commonest and most lethal cancers throughout the world. The epidemiological and pathological profile varies among different ethnicities and geographical regions. At present adenocarcinoma is the commonest histological subtype of non-small cell lung cancer (NSCLC) in most of the Western and Asian countries. However, in India squamous cell carcinoma has been reported as the commonest histological type in most of the series. The aim of the study was to analyze the current clinico-pathological profile and survival of lung cancer at our centre. Materials and Methods: We analyzed 434 pathologically confirmed lung cancer cases registered at our centre over a period of three years. They were evaluated for their clinical and pathological profiles, treatment received and outcome. The available histology slides were reviewed by an independent reviewer. Results: Median age was 55 years with a male:female ratio of 4.6:1. Some 68% of patients were smokers. There were 85.3% NSCLC and 14.7% SCLC cases. Among NSCLCs, adenocarcinoma was the commonest histological subtype after the pathology review. Among NSCLC, 56.8% cases were of stage IV while among SCLC 71.8% cases had extensive stage disease. Some 29% of patients did not receive any anticancer treatment. The median overall and progression free survivals of the patients who received treatment were 12.8 and 7.8 months for NSCLC and 9.1 and 6.8 months for SCLC. Conclusions: This analysis suggests that adenocarcinoma may now be the commonest histological subtype also in India, provided a careful pathological review is done. Most of the patients present at advanced stage and outcome remains poor.

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Section: Discussionmentioning

confidence: 99%

Clinico-pathological Profile of Lung Cancer at AIIMS: A Changing Paradigm in India

Malik¹,

Sharma²,

Mohanti³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Despite advances in anticancer therapies, survival benefits in patients with lung cancer over the past 30 years have been relatively small compared with those seen in breast, colorectal and prostate cancers 22. While reasons for this are complex, many patients with lung cancer are ineligible for radical treatment at presentation due to poor PS or comorbidity, while others fail to receive their intended treatment plan because of functional decline 23 24. Non-small cell lung cancer (NSCLC) has a particularly strong association with loss of muscle mass—of 441 patients consecutively referred to a regional oncology service, 47% were found to be sarcopenic 25.…”

Section: Introductionmentioning

confidence: 99%

The assessment and impact of sarcopenia in lung cancer: a systematic literature review

et al. 2014

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ObjectivesThere is growing awareness of the relationship between sarcopenia (loss of muscle mass and function), and outcomes in cancer, making it a potential target for future therapies. In order to inform future research and practice, we undertook a systematic review of factors associated with loss of muscle mass, and the relationship between muscle function and muscle mass in lung cancer, a common condition associated with poor outcomes.DesignWe conducted a computerised systematic literature search on five databases. Studies were included if they explored muscle mass as an outcome measure in patients with lung cancer, and were published in English.SettingSecondary care.ParticipantsPatients with lung cancer.Primary outcomeFactors associated with loss of muscle mass and muscle function, or sarcopenia, and the clinical impact thereof in patients with lung cancer.ResultsWe reviewed 5726 citations, and 35 articles were selected for analysis. Sarcopenia, as defined by reduced muscle mass alone, was found to be very prevalent in patients with lung cancer, regardless of body mass index, and where present was associated with poorer functional status and overall survival. There were diverse studies exploring molecular and metabolic factors in the development of loss of muscle mass; however, the precise mechanisms that contribute to sarcopenia and cachexia remain uncertain. The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results. There are very limited data on the correlation between degree of sarcopenia and muscle function, which has a non-linear relationship in older non-cancer populations.ConclusionsLoss of muscle mass is a significant contributor to morbidity in patients with lung cancer. Loss of muscle mass and function may predate clinically overt cachexia, underlining the importance of evaluating sarcopenia, rather than weight loss alone. Understanding this relationship and its associated factors will provide opportunities for focused intervention to improve clinical outcomes.

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“…It has been recently shown that multidisciplinary cancer care and meetings enhance the adherence to guideline-and evidence-based care in NSCLC. 19,20 The stage at diagnosis was the only factor shown to correlate with the treatment guideline adherence rate in our cohort, with patients with advanced (stage IV) NSCLC having a higher rate of nonadherence to treatment guidelines. The most common practice that deviated from evidence-based care was the use of cytotoxic chemotherapies of unproven value as a third-line regimen in patients with stage IV NSCLC.…”

Section: Discussionmentioning

confidence: 80%

Patterns of Care for Non–Small-Cell Lung Cancer at an Academic Institution Affiliated With a National Cancer Institute–Designated Cancer Center

Nguyen

Sanford

Huberman

et al. 2012

JOP

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Purpose: Evidence-based treatment guidelines for non-smallcell lung cancer (NSCLC) exist to improve the quality of care for patients with this disease. However, how often evidence-based decisions are used for care of NSCLC is poorly understood. Results: Eighty-one percent of the patients were white, the mean age was 66 years, 49% were women, 11% were never smokers, 83% had Eastern Cooperative Oncology Group performance status 0 to 1, 49.7% of tumors were adenocarcinomas, 57.1% of never smokers had tumors genotyped (EGFR, ALK, KRAS), and 13.3% participated in clinical trials. The rate of evidence-based treatment adherence was 94.1% (16 of 17), 100% (21 of 21) and 100% (36 of 36) in patients with stages I, II, and III NSCLC, respectively. Stage IV disease, with adherence of 76.3% (58 of 76), was correlated with a higher rate of nonadherence when compared with stages I-III (odds ratio 16.33; 95% CI, 1.94 to 137.73). In patients with stage IV disease, the rate of evidence-based adherence was 95% (72 of 76) for first-line therapy, 95.2% (40 of 42) for second-line therapy, and only 33.3% (6 of 18) for third-line therapy (P Ͻ .001). There was no significant correlation between evidence-based adherence status and the patient's age, sex, performance status, smoking history, ethnicity, or the treating physician. Patients and Methods Conclusion:These data point toward the need for improved evidence-based use of resources in the third-line setting of stage IV NSCLC.

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Why Do Some Lung Cancer Patients Receive No Anticancer Treatment?

Abstract: The proportion of patients with lung cancer receiving no treatment is greater than that predicted by guidelines or recommended by the MDM but lower than that described in population-based studies suggesting that MDMs can improve treatment utilization in lung cancer.

Cited by 55 publications

References 31 publications

Clinico-pathological Profile of Lung Cancer at AIIMS: A Changing Paradigm in India

Clinico-pathological Profile of Lung Cancer at AIIMS: A Changing Paradigm in India

The assessment and impact of sarcopenia in lung cancer: a systematic literature review

Patterns of Care for Non–Small-Cell Lung Cancer at an Academic Institution Affiliated With a National Cancer Institute–Designated Cancer Center

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