Disparities in the management of stage I small cell lung carcinoma (SCLC): A National Cancer Database (NCDB) analysis.

Abstract

8563 Background: Effective treatment of stage I SCLC requires both surgical resection and chemotherapy. We analyzed the National Cancer Database (NCDB) for the treatment patterns and disparities in the management of stage I SCLC. Methods: We identified patients with clinical stage I SCLC from the NCDB. Median and 5-year survival were calculated using Kaplan Meier analysis. Multivariable logistic regression model was used to determine the factors that can predict surgical resection. Results: We identified 4,849 patients with clinical stage I SCLC diagnosed between 2004 and 2012. We divided them into 4 treatment groups; surgical resection with chemotherapy (n = 774, 15.9%), surgical resection without chemotherapy (n = 423, 8.7%), non-surgical treatment (n = 2,978, 61.4%) and no treatment (n = 674, 13.9%). 5-year survival for each group was 47%, 36%, 22% and 11% respectively, ( p-value < 0.001). Among patients who underwent surgical resection, lobectomy (67.1%) was the most common procedure followed by sub-lobar resection (28.8%) and pneumonectomy (2.8%) with 5-year survival of 48%, 34% and 33% respectively, ( p-value < 0.001). Multivariate analysis identified that elderly (age ≥ 70) patients, African-Americans, patients with low income and Medicaid are less likely to undergo surgery, ( p-value < 0.001). Patients receiving treatment at academic cancer centers, right sided tumors and Charlson score ≥ 1 are more likely to receive surgery, ( p-value < 0.001). Conclusions: Despite better outcomes only 25% of patients undergo surgery for stage I SCLC. Over the years there has been only a modest increase in the proportion of patients undergoing resection. We have identified significant disparities in the treatment of patients with stage I SCLC. Our data clearly show the need to educate physicians on appropriate delivery of care for patients with stage I SCLC.