Intercycle Delays during Chemotherapy of Non-small Cell Lung Cancer in a Health Care Resource-Constrained Setting and Their Effect on Overall Survival

Abstract

A prospective study was conducted at the lung cancer clinic of a tertiary care institute to assess the incidence of and reasons for intercycle delays (ICD) during chemotherapy of patients with non-small cell lung cancer (NSCLC). The effect of ICD on overall survival was also assessed. Data were collected for all newly diagnosed NSCLC patients who were initiated on and completed chemotherapy during a 12-month period. Differences between patients who experienced ICD (ICD+ group) versus those who did not (ICD- group) were analyzed. Survival probabilities and median survivals were calculated by Kaplan-Meier method, and group differences were analyzed using the log-rank test. Of the 118 chemonaive NSCLC patients who received chemotherapy, 100 received > or =2 cycles and were included in data analysis. A total of 441 cycles were administered with ICD amounting to 683 days being noted during 84 (19.1%) cycles in 57 patients. The most common reasons for ICD were nonavailability of blood tests reports (25.5%), severe anemia (20.2%), and hospital holidays on scheduled days of chemotherapy (9.6%). ICD+ and ICD- groups did not differ with respect to age, gender, smoking status, histology, stage of disease, baseline performance status, chemotherapy regimen, or number of cycles administered. Median survival in ICD+ and ICD- groups was similar (247 [95% confidence interval 188-306 days] and 232 days [95% confidence interval 196-268 days], respectively). ICD are common during chemotherapy of NSCLC patients in our institute. Factors unrelated to disease status or chemotherapy regimen are important reasons. ICD did not affect overall survival in the current study.