Factors associated with adherence to chemotherapy guidelines in patients with non-small cell lung cancer (NSCLC).

Abstract

7067 Background: Evidence-based guidelines recommend chemotherapy for medically fit NSCLC stage II-IV patients. Understanding the extent to which practice is consistent with guidelines as well as the compliance-associated factors is often not done because performance status (PS), a key clinical component in assessing chemotherapy appropriateness, is typically missing from claims-based datasets. Among a cohort of patients with known PS, we describe chemotherapy use concordance with ASCO guidelines and identify patient and other factors associated with guideline adherent use. Methods: A cohort of insured patients in a managed care environment, ages 50+, stage II-IV NSCLC between 2000-2007 identified via a tumor registry (n=406). Chart abstracted PS, automated medical claims, census tract information, and travel distance, linked to tumor registry data. Chemotherapy was considered recommended for patients with good (0-2) PS. Multivariate models were fit to evaluate characteristics associated with chemotherapy use. Results: Overall compliance with chemotherapy guidelines was 71%. Significant (p<0.05) predictors of chemotherapy underuse (19%) included increasing age (odds ratio [OR], 1.09), increasing income (OR, 1.02), diagnosed prior to 2003 (OR, 2.05), lower college graduation rate (OR, 0.93) and vehicle access in the patient’s neighborhood (OR, 6.96). Significant predictors of chemotherapy overuse (10%) included decreasing age (OR, 0.92), diagnosed after 2003 (OR, 3.24), lower college graduation rate (OR, 0.89) and increasing income in the patient’s neighborhood (OR, 1.05). Conclusions: Among NSCLC patients, almost one third do not receive chemotherapy concordant with guidelines. Care concordant with guidelines is influenced by the patient’s age, and economic considerations such as income, education, and presence of transportation barriers. For the 219,440 people in the US diagnosed with lung cancer there are opportunities to increase both up-front curative and palliative care for good PS patients, and to diminish chemotherapy use for poor PS patients with no medical harm, better use of hospice, and fewer costly end of life hospitalizations.