Guideline concordant care improves overall survival for locally advanced non-small cell lung carcinoma patients: a National Cancer Data Base analysis. Open Access

Abstract

Introduction: Current evidence-based guideline-concordant care (GCC) for locally advanced non-small cell lung cancer (NSCLC) in patients with good performance status includes platinum-based chemotherapy during thoracic radiotherapy (TRT). This study evaluates factors associated with lack of GCC.

Patients and methods: Unresected stage III NSCLC patients, diagnosed from 2005 - 2013 with a Charlson-Deyo Score 0, were identified from the National Cancer Data Base. Primary outcomes were receipt of GCC, defined as administration of chemotherapy with TRT commencing within 2 weeks of each other and minimum TRT dose of 60 Gy, and overall survival (OS).

Results: About 23% of patients (n=45,825) received GCC. Uninsured patients were more likely to receive non-GCC (odds ratio [OR]=1.54, p<0.001) compared to privately-insured patients. Other groups with greater odds of receiving non-GCC included: patients treated in the western, southern, or northeastern U.S. (ORs=1.39, 1.37, 1.19, respectively, all p values <0.001) compared to patients treated in the Midwest; those with adenocarcinoma (OR=1.48, p<0.001) compared to those with squamous cell carcinoma ; and women (OR=1.08, p=0.002) compared to men. Every one-year increase in age, increased a patient's odds of not receiving GCC by 4% (p<0.001). Those receiving non-GCC had higher death rates compared to those receiving GCC (hazard ratio [HR]=1.42, p<0.001). Other groups with lower survival for non-GCC versus GCC included : the uninsured (HR=1.53, p<0.001), patients treated in the western, southern, or northeastern US (HRs= 1.56, 1.41, 1.34, respectively, all p<0.001), adenocarcinomas (HR=1.39, p<0.001), and women (HR=1.44, p<0.001).

Conclusion: Socioeconomic factors, including lack of insurance and geography, are associated with lack of GCC. Patient/disease specific factors, including increasing age, adenocarcinoma histology, and sex, are also associated with non-GCC.

Table of Contents

Background 1

Methods 4

Results 6

Discussion 8

References 13

Tables 21

Figures 33

Figure Legends 51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Oncology Health Sciences, Epidemiology
Keyword	guideline concordant care survival outcomes concurrent chemoradiation socioeconomic risk factors non-small cell lung cancer
Committee Chair / Thesis Advisor	Higgins, Kristin, Emory University Goodman, Michael, Emory University
Committee Members	Liu, Yuan, Emory University Gillespie, Theresa Wicklin, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs National or regional non-profit organization (e.g., American Cancer Society)

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