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

Ahmed, Hiba Zara (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/j3860784w?locale=en
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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

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