Social factors, treatment, and survival in patients with advanced-stage non-small cell lung cancer

Abstract

Background: Lung cancer is the leading cause of cancer death in North America with at least 40% of patients presenting with advanced, incurable non-small cell cancer (NSCLC) at the time of diagnosis. Chemotherapy has been shown to increase median survival in patients with a good performance status [Eastern Cooperative Oncology Group (ECOG) 0, 1, or 2]. Objective: To determine factors associated with treatment in patients presenting with advanced NSCLC in two academic community-based hospital settings. Methods: Data were extracted from the 2009-2010 Scripps Cancer Registry. Advanced NSCLC patients were followed from initial diagnosis until death. The influence of socioeconomic status, performance status and access to care on the decision to pursue treatment and the correlating overall survival was assessed. Results: Chemotherapy was given to 64% of 111 patients from Scripps Mercy Hospital (SMH) and Scripps Green Hospital (SGH) diagnosed with advanced NSCLC. Chemotherapy was given to 58.8% of SMH patients and 78.3% of SGH patients (P=0.03). Patients with an ECOG status between 0-2 were more likely to receive chemotherapy compared with patients whose ECOG status was 3-4 (81% versus 0%, respectively, P<0.001). Those tested for the epidermal growth factor (EGFR) mutation were more likely to receive chemotherapy, compared to those not tested (96% versus 60%, P<0.001). Conclusions: Chemotherapy utilization for advanced NSCLC is increasing over time. Chemotherapy administration is associated with socioeconomic status, performance status, and access to care, relationships that likely reflect evolving clinical practice patterns.