Abstract
Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. Using the Glans-Look Lung Cancer database, we completed a chart review of stage iv nsclc patients diagnosed in Southern Alberta during 2003-2006 and 2010-2011, comparing median overall survival (mos), referral, and treatment in the two cohorts. Of the 922 patients diagnosed in 2003-2006 and the 560 diagnosed in 2010-2011, 94% and 82% respectively were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival. Our experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.
Highlights
Approximately 25% of stage iv non-small-cell lung cancer patients receive systemic therapy
Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral
With the introduction of targeted therapy and immunotherapy as part of standard treatment in stage iv nsclc, patients who would have not benefited from traditional cytotoxic chemotherapy can benefit from timely referral to medical oncology and other forms of systemic therapy
Summary
Approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. Nonsmall-cell lung cancer (nsclc) accounts for 85% of all lung cancer cases, with 40% of the affected patients presenting with stage iv disease[3]. With the introduction of targeted therapy and immunotherapy as part of standard treatment in stage iv nsclc, patients who would have not benefited from traditional cytotoxic chemotherapy (tctx) can benefit from timely referral to medical oncology (mo) and other forms of systemic therapy. The referral rates to mo are estimated to be 50% –70% for all nsclc patients and 30% –60% for all advanced nsclc patients[13,14,15,16,17]
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