Factors Predicting for Early Mortality in Non-Small Cell Lung Cancer

Abstract

Lung cancer remains the leading cause of cancer related death in men and women in the US. The US Preventive Service Task Force recommends annual screening for lung cancer with low-dose computed tomography in high risk individuals in order to detect lung cancer at earlier stages and reduce rates of lung-cancer mortality. This study assesses factors associated with early mortality (30 days from initial diagnosis) in non-small cell lung cancer (NSCLC) during the last decade. The National Cancer Database was queried for patients ≥ 18 years with NSCLC treated from 2006-2015. Patients included had known follow up at 30 days from diagnosis. Survival interval was calculated from the date of diagnosis to the date of death. Two categories were selected: patients who died within 30 days of diagnosis and those who lived longer than 30 days. Univariate and multivariate logistic regression was used to assess variables associated with early mortality. Variables included: age, sex, race, insurance, facility type, region of country, population density, income, education level, comorbidity score, year of diagnosis, and AJCC overall clinical stage. A total of 974,732 patients were included; 70,167 (7.2%) died within 30 days of their diagnosis. Under multivariate logistic regression comparing those who died within 30 days to those who lived longer than 30 days, older age (odds ratio [OR] 1.03; p<0.001), higher Charlson comorbidity score (OR 1.42; p<0.001), patients with Medicare (OR 1.10; p<0.001), Medicaid/other government insurance (OR 1.25; p<0.001), or no insurance (OR 2.02; p<0.001) were all significant predictors for early mortality. Higher overall clinical stage also predicted for early mortality: stage II (OR 2.01), III (OR 3.31), IV (OR 7.87), not staged (OR 5.95) vs. I (all p<0.001). Of those who died within 30 days from diagnosis, 45,861 (65%) presented with stage IV disease (p<0.001). Factors associated with a lower odds of 30 day mortality included diagnosis in more recent years and receipt of care at comprehensive community cancer programs (OR 0.93), academic (OR 0.77), and integrated network cancer programs (OR 0.89) when compared to community programs (all p<0.001). Female patients (OR 0.82; p<0.001), those in higher income counties (ORs 0.86-0.93; all p<0.001), and patients living in areas with higher high-school graduation rates (OR 0.92, p<0.001) were also less likely to die within 30 days of their diagnosis. Approximately 7% of newly diagnosed NSCLC patients have died within 30 days of their diagnosis over the past decade. The majority of these individuals (65%) present with stage IV disease. Increasing awareness about lung cancer screening programs, improvements in access to care, and better medical optimization especially for elderly patients with multiple comorbidities may help further reduce the rates of early mortality in NSCLC.