Guideline-concordant Care Improves Overall Survival for Locally Advanced Non–Small-cell Lung Carcinoma Patients: A National Cancer Database Analysis
| Autor: | Walter J. Curran, Kelli O'Connell, Yuan Liu, Maaz Z. Ahmed, Theresa W. Gillespie, Richard J. Cassidy, Conor E. Steuer, Madhusmita Behera, Hiba Z. Ahmed, Rathi N. Pillai, Kristin Higgins, Taofeek K. Owonikoko, Pretesh Patel, Suresh S. Ramalingam |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Oncology Cancer Research medicine.medical_specialty Lung Neoplasms Adolescent Databases Factual Adenocarcinoma Young Adult 03 medical and health sciences Sex Factors 0302 clinical medicine Carcinoma Non-Small-Cell Lung Internal medicine medicine Carcinoma Humans 030212 general & internal medicine Lung cancer Aged Neoplasm Staging Proportional Hazards Models Retrospective Studies Aged 80 and over Evidence-Based Medicine Performance status business.industry Mortality rate Hazard ratio Cancer Chemoradiotherapy Odds ratio Middle Aged medicine.disease United States Surgery Survival Rate Logistic Models Socioeconomic Factors 030220 oncology & carcinogenesis Practice Guidelines as Topic Carcinoma Squamous Cell Female business |
| Zdroj: | Clinical Lung Cancer. 18:706-718 |
| ISSN: | 1525-7304 |
| DOI: | 10.1016/j.cllc.2017.04.009 |
| Popis: | Current evidence-based guideline-concordant care (GCC) for locally advanced non-small-cell lung cancer (NSCLC) patients with good performance status is concurrent chemoradiation. In this study we evaluated factors associated with lack of GCC and its effects on overall survival (OS).Unresectable stage III NSCLC patients, diagnosed from 2005 to 2013 with a Charlson-Deyo score of 0, were identified from the National Cancer Database. Primary outcomes were receipt of GCC, defined as concurrent chemoradiation (thoracic radiotherapy, starting within 2 weeks of chemotherapy, to at least 60 Gy), and OS. Multivariable logistic regression modeling identified variables associated with non-GCC. Cox proportional hazard modeling was used to examine OS.Twenty-three percent of patients (n = 10,476) received GCC. Uninsured patients were more likely to receive non-GCC (odds ratio [OR], 1.54; P .001) compared with privately insured patients. Other groups with greater odds of receiving non-GCC included: patients treated in the western, southern, or northeastern United States (ORs, 1.39, 1.37, and 1.19, respectively; all Ps .001) compared with the Midwest; adenocarcinoma histology (OR, 1.48; P .001) compared with squamous cell carcinoma; and women (OR, 1.08; P = .002). Those who received non-GCC had higher death rates compared with those who received GCC (hazard ratio [HR], 1.42; P .001). The uninsured (HR, 1.53; P .001), patients treated in the western, southern, or northeastern United States (HRs, 1.56, 1.41, and 1.34, respectively; P .001), adenocarcinomas (HR, 1.39; P .001), and women (HR, 1.44; P .001) also all had lower OS for non-GCC versus GCC.Socioeconomic factors, including lack of insurance and geography, are associated with non-GCC. Patient- and disease-specific factors, including increasing adenocarcinoma histology and sex, are also associated with non-GCC. Non-GCC diminishes OS. |
| Databáze: | OpenAIRE |
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