Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not

Stephanie Y. Brule, Khalid Al-Baimani, Hannah Jonker, Tinghua Zhang, Garth Nicholas, Glenwood Goss, Scott A. Laurie, Paul Wheatley-Price

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Palliative systemic therapy (ST) in advanced non-small cell lung cancer (NSCLC) is associated with improved overall survival (OS) and quality of life, yet many patients remain untreated. We explored differences between patients who did and did not receive palliative ST in order to gain evidence to support and advocate for the untreated. Methods: We performed a retrospective analysis of newly diagnosed patients with advanced, incurable NSCLC seen as outpatients at our institution between 2009 and 2012. Demographics, treatment, and survival data were collected. Results: 528 patients were seen: 291 (55%) received palliative ST, while 237 (45%) received none. Demographics were as follows: Median age 67, 55% male, 50% ECOG performance status (PS) 0-1, 48% with weight loss. Untreated patients were older (median 71 vs. 64, p < 0.01), less fit (PS 0-1 in 27% vs. 69%, p < 0.01), and more likely to have lost weight (57% vs. 41%, p < 0.01). Reasons for no treatment included poor PS (67%) and patient choice (23%). Median OS was shorter amongst untreated patients (3.9 vs. 10.7 months, HR 1.80 [95% CI 1.4-2.3], p < 0.01). In multivariate analysis, not receiving ST was associated with shorter OS. Conclusion: Unsurprisingly, untreated patients had poorer prognostic features and worse OS. However, it is concerning that, despite being seen in an active academic center, nearly half of all referred patients with advanced NSCLC received no anti-cancer treatment. Current research primarily seeks to improve outcomes in treated patients with good PS. This review suggests that this is an inappropriate allocation of research effort. Our research should be more equitably split between good and poor performance patient groups if we are to improve the survival of all patients with advanced NSCLC. Potential strategies include more rapid diagnosis prior to functional decline, and the development of therapies effective and tolerated in a sicker population.

Original languageEnglish
Pages (from-to)15-21
Number of pages7
JournalLung Cancer
Volume97
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Palliative Care
Non-Small Cell Lung Carcinoma
Survival
Research
Demography
Therapeutics
Weight Loss
Outpatients
Multivariate Analysis
Quality of Life
Weights and Measures

Keywords

  • Advocacy
  • Best supportive care
  • Chemotherapy
  • Non-small cell lung cancer
  • Palliative
  • Palliative systemic therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Palliative systemic therapy for advanced non-small cell lung cancer : Investigating disparities between patients who are treated versus those who are not. / Brule, Stephanie Y.; Al-Baimani, Khalid; Jonker, Hannah; Zhang, Tinghua; Nicholas, Garth; Goss, Glenwood; Laurie, Scott A.; Wheatley-Price, Paul.

In: Lung Cancer, Vol. 97, 01.07.2016, p. 15-21.

Research output: Contribution to journalArticle

Brule, Stephanie Y. ; Al-Baimani, Khalid ; Jonker, Hannah ; Zhang, Tinghua ; Nicholas, Garth ; Goss, Glenwood ; Laurie, Scott A. ; Wheatley-Price, Paul. / Palliative systemic therapy for advanced non-small cell lung cancer : Investigating disparities between patients who are treated versus those who are not. In: Lung Cancer. 2016 ; Vol. 97. pp. 15-21.
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abstract = "Background: Palliative systemic therapy (ST) in advanced non-small cell lung cancer (NSCLC) is associated with improved overall survival (OS) and quality of life, yet many patients remain untreated. We explored differences between patients who did and did not receive palliative ST in order to gain evidence to support and advocate for the untreated. Methods: We performed a retrospective analysis of newly diagnosed patients with advanced, incurable NSCLC seen as outpatients at our institution between 2009 and 2012. Demographics, treatment, and survival data were collected. Results: 528 patients were seen: 291 (55{\%}) received palliative ST, while 237 (45{\%}) received none. Demographics were as follows: Median age 67, 55{\%} male, 50{\%} ECOG performance status (PS) 0-1, 48{\%} with weight loss. Untreated patients were older (median 71 vs. 64, p < 0.01), less fit (PS 0-1 in 27{\%} vs. 69{\%}, p < 0.01), and more likely to have lost weight (57{\%} vs. 41{\%}, p < 0.01). Reasons for no treatment included poor PS (67{\%}) and patient choice (23{\%}). Median OS was shorter amongst untreated patients (3.9 vs. 10.7 months, HR 1.80 [95{\%} CI 1.4-2.3], p < 0.01). In multivariate analysis, not receiving ST was associated with shorter OS. Conclusion: Unsurprisingly, untreated patients had poorer prognostic features and worse OS. However, it is concerning that, despite being seen in an active academic center, nearly half of all referred patients with advanced NSCLC received no anti-cancer treatment. Current research primarily seeks to improve outcomes in treated patients with good PS. This review suggests that this is an inappropriate allocation of research effort. Our research should be more equitably split between good and poor performance patient groups if we are to improve the survival of all patients with advanced NSCLC. Potential strategies include more rapid diagnosis prior to functional decline, and the development of therapies effective and tolerated in a sicker population.",
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AU - Brule, Stephanie Y.

AU - Al-Baimani, Khalid

AU - Jonker, Hannah

AU - Zhang, Tinghua

AU - Nicholas, Garth

AU - Goss, Glenwood

AU - Laurie, Scott A.

AU - Wheatley-Price, Paul

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N2 - Background: Palliative systemic therapy (ST) in advanced non-small cell lung cancer (NSCLC) is associated with improved overall survival (OS) and quality of life, yet many patients remain untreated. We explored differences between patients who did and did not receive palliative ST in order to gain evidence to support and advocate for the untreated. Methods: We performed a retrospective analysis of newly diagnosed patients with advanced, incurable NSCLC seen as outpatients at our institution between 2009 and 2012. Demographics, treatment, and survival data were collected. Results: 528 patients were seen: 291 (55%) received palliative ST, while 237 (45%) received none. Demographics were as follows: Median age 67, 55% male, 50% ECOG performance status (PS) 0-1, 48% with weight loss. Untreated patients were older (median 71 vs. 64, p < 0.01), less fit (PS 0-1 in 27% vs. 69%, p < 0.01), and more likely to have lost weight (57% vs. 41%, p < 0.01). Reasons for no treatment included poor PS (67%) and patient choice (23%). Median OS was shorter amongst untreated patients (3.9 vs. 10.7 months, HR 1.80 [95% CI 1.4-2.3], p < 0.01). In multivariate analysis, not receiving ST was associated with shorter OS. Conclusion: Unsurprisingly, untreated patients had poorer prognostic features and worse OS. However, it is concerning that, despite being seen in an active academic center, nearly half of all referred patients with advanced NSCLC received no anti-cancer treatment. Current research primarily seeks to improve outcomes in treated patients with good PS. This review suggests that this is an inappropriate allocation of research effort. Our research should be more equitably split between good and poor performance patient groups if we are to improve the survival of all patients with advanced NSCLC. Potential strategies include more rapid diagnosis prior to functional decline, and the development of therapies effective and tolerated in a sicker population.

AB - Background: Palliative systemic therapy (ST) in advanced non-small cell lung cancer (NSCLC) is associated with improved overall survival (OS) and quality of life, yet many patients remain untreated. We explored differences between patients who did and did not receive palliative ST in order to gain evidence to support and advocate for the untreated. Methods: We performed a retrospective analysis of newly diagnosed patients with advanced, incurable NSCLC seen as outpatients at our institution between 2009 and 2012. Demographics, treatment, and survival data were collected. Results: 528 patients were seen: 291 (55%) received palliative ST, while 237 (45%) received none. Demographics were as follows: Median age 67, 55% male, 50% ECOG performance status (PS) 0-1, 48% with weight loss. Untreated patients were older (median 71 vs. 64, p < 0.01), less fit (PS 0-1 in 27% vs. 69%, p < 0.01), and more likely to have lost weight (57% vs. 41%, p < 0.01). Reasons for no treatment included poor PS (67%) and patient choice (23%). Median OS was shorter amongst untreated patients (3.9 vs. 10.7 months, HR 1.80 [95% CI 1.4-2.3], p < 0.01). In multivariate analysis, not receiving ST was associated with shorter OS. Conclusion: Unsurprisingly, untreated patients had poorer prognostic features and worse OS. However, it is concerning that, despite being seen in an active academic center, nearly half of all referred patients with advanced NSCLC received no anti-cancer treatment. Current research primarily seeks to improve outcomes in treated patients with good PS. This review suggests that this is an inappropriate allocation of research effort. Our research should be more equitably split between good and poor performance patient groups if we are to improve the survival of all patients with advanced NSCLC. Potential strategies include more rapid diagnosis prior to functional decline, and the development of therapies effective and tolerated in a sicker population.

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