Guideline-concordant care improves overall survival for locally advanced non–small-cell lung carcinoma patients: A National Cancer Database Analysis Journal Article


Authors: Ahmed, H. Z.; Liu, Y.; O'Connell, K.; Ahmed, M. Z.; Cassidy, R. J.; Gillespie, T. W.; Patel, P.; Pillai, R. N.; Behera, M.; Steuer, C. E.; Owonikoko, T. K.; Ramalingam, S. S.; Curran, W. J.; Higgins, K. A.
Article Title: Guideline-concordant care improves overall survival for locally advanced non–small-cell lung carcinoma patients: A National Cancer Database Analysis
Abstract: Micro-Abstract Several socioeconomic factors, including lack of insurance and geography, and patient- and disease-specific factors, including increasing adenocarcinoma histology and sex, are associated with receipt of non–guideline-concordant care. Non–guideline-concordant care is associated with poorer survival outcomes. Background 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). Patients and Methods 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. Results 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. Conclusion 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. © 2017 Elsevier Inc.
Keywords: cancer survival; controlled study; aged; major clinical study; overall survival; advanced cancer; united states; cancer patient; cancer staging; antineoplastic agent; cohort analysis; practice guideline; patient care; lung adenocarcinoma; guidelines; socioeconomics; chemoradiotherapy; non small cell lung cancer; concurrent chemoradiation; clinical outcome; survival outcomes; human; male; female; article; medically uninsured; squamous cell lung carcinoma; locally advanced non-small cell lung care; socioeconomic risk factors
Journal Title: Clinical Lung Cancer
Volume: 18
Issue: 6
ISSN: 1525-7304
Publisher: Elsevier Inc.  
Date Published: 2017-11-01
Start Page: 706
End Page: 718
Language: English
DOI: 10.1016/j.cllc.2017.04.009
PROVIDER: scopus
PUBMED: 28601387
DOI/URL:
Notes: Article -- Export Date: 1 December 2017 -- Source: Scopus
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