Physician practice of statin usage and lipid monitoring among patients with advanced lung cancer

Abstract

8009 Background: The benefit of statins (HMG-CoA reductase inhibitors) for prevention of cardiovascular disease is well established; however, its use among patients with advanced cancers with limited life expectancy is controversial. Besides, the risk of liver dysfunction may increase among patients with liver metastasis or receiving chemotherapy. We investigate physician practices of prescribing statin and monitoring lipids among advanced lung cancer patients. Methods: Cancer registry at a large, suburban VA hospital was searched for deceased patients who presented with metastatic or stage IIIB non-small cell lung cancer (NSCLC) or extensive stage small cell lung cancer during 1999 to 2003. Patients were included if they were on statins at or after the time of cancer diagnosis, survived for at least one month after diagnosis, and had at least one documented contact with their physicians within 6 months before death. Results: Fifty patients met the search criteria: 49 were on statins at the time of cancer diagnosis, and 1 was started on statin afterward. Median age was 71 years, 26% had extensive stage SCLC, 52% metastatic NSCLC, and 22% stage IIIB NSCLC. Most had history of cardiovascular disease or diabetes. The overall median survival was 360 days. There were 42 patients (84%) who had statin prescription filled at least once after cancer diagnosis. Of these, 16 (38%) continued to have adequate supply until death. Median duration from the last statin medication until death was 72 days. Lipid was monitored at least once after cancer diagnosis in 26 patients (52%). Of these, the median duration from the last test until death was 149 days. Meanwhile, hospice referral before death was initiated in 31 patients (62%). Of these, the median duration from the date of hospice referral until death was 30 days. Conclusions: The majority of patients with advanced lung cancer who received statins continued this medication until near the date of death; lipid monitoring was also prevalent. Effort should be made to re-direct patients and physicians to other realistically beneficial interventions. No significant financial relationships to disclose.