Adoption of adjuvant chemotherapy for non-small cell lung cancer: A population-based outcomes study.

Abstract

7018 Background: Since 2004 several clinical trials have demonstrated that adjuvant chemotherapy (ACT) improves survival in patients with non-small cell lung cancer (NSCLC). Here we evaluate the uptake of ACT and its impact on outcomes in the general population of Ontario, Canada. Methods: All cases of NSCLC diagnosed in Ontario 2001-2006 who underwent surgical resection (N=6,311) were identified using the population-based Ontario Cancer Registry (OCR). The OCR captures diagnostic and demographic information on ∼98% of all incident cancer cases in Ontario. We linked electronic records of treatment to the registry. We described time trends in the uptake of ACT and compared hospitalizations and survival of all surgical patients diagnosed 2001-2003 with those diagnosed 2004-2006. Results: Demographic, disease, and treatment-related characteristics did not differ between the 2001-2003 and 2004-2006 cohorts. Over the study period the proportion of cases receiving ACT increased from 7% (192/2,953) to 31% (1,034/3,358, p<0.0001). In 2004-2006, ACT was used in 60% of cases with resected stage II/III disease. Among cases for which drug details were available, 82% of patients received cisplatin and 16% received carboplatin-based therapy. The proportion of cases admitted to hospital remained stable between 2001-2003 and 2004-2006: 36 and 37% within 6 months of surgery. However, within 2 years of surgery there was a 34% reduction in cases admitted to hospital with metastatic disease (p<0.0001). During the study period there was a substantial improvement in 4-year survival among all surgical cases from 52.5 to 56.1%, p=0.007. Younger age, less co-morbidity, shorter length of surgical hospital stay, more extensive surgery, stage II/III disease, and region where surgery was performed were independently associated with administration of ACT. Conclusions: There has been rapid uptake of ACT for NSCLC which is not associated with an increased rate of hospitalization. The adoption of ACT is associated with a substantial improvement in overall survival suggesting benefits seen in the relevant clinical trials are generalizable to the general population. Efforts to reduce underutilization of ACT in clinical practice are needed. No significant financial relationships to disclose.