Reasons for lack of referral to medical oncology for systemic therapy in stage IV non-small-cell lung cancer: comparison of 2003–2006 with 2010–2011

Current oncology

J.J. Ko¹  M. Liu²  K. Skolnik³  R. Tudor⁴  D. Morris⁴  J. Macklow⁴  D.G. Bebb⁴  H. Li⁵  W. Kells Boland⁶ 

[1] Abbotsford Cancer Centre, BC Cancer Agency, University of British Columbia;Alberta Health Services;Faculty of Medicine;Tom Baker Cancer Centre;University of Calgary;Weill Cornell Medical College

关键词: Non-small-cell lung cancer;    stage iv;    chemotherapy;    targeted therapy;    immunotherapy;    survival;    referral patterns;    reasons for no treatment;   

DOI  :  10.3747/co.24.3691

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

Introduction Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. MethodsUsing the Glans–Look Lung Cancer database, we completed a chart review of stage iv nsclc patients diagnosed in Southern Alberta during 2003–2006 and 2010–2011, comparing median overall survival (mos), referral, and treatment in the two cohorts. ResultsOf the 922 patients diagnosed in 2003–2006 and the 560 diagnosed in 2010–2011, 94% and 82% respectively were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival ( p< 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months,p= 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16;p= 0.008] and pulmonary embolus (hr: 1.2;p= 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5;p< 0.001) and enrolment in a clinical trial (hr: 0.76;p= 0.049) correlated with better survival. ConclusionsOur experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

【 授权许可】

Unknown