Use of chemotherapy for advanced non-small cell lung cancer in a contemporary and diverse patient population.

Abstract

e18006 Background: Despite evidence that chemotherapy prolongs survival, without substantially impairing quality of life, for patients with advanced non-small cell lung cancer (NSCLC), population-based studies have shown that only 20-30% of these patients receive systemic therapy. However, these studies have relied on Medicare-based data—hence including only patients aged ≥ 65 years. We therefore determined the use of chemotherapy in a contemporary NSCLC population encompassing all patient ages. Methods: We performed a retrospective analysis of consecutive patients diagnosed with stage IV NSCLC from 2000 to 2007 at the University of Texas Southwestern Medical Center. Demographic, tumor, and treatment data were obtained from hospital tumor registries and individual patient records. The association between these variables was assessed using univariate analysis, multivariate logistic regression, and survival analysis. Results: A total of 718 patients met criteria for analysis. Mean age was 64 years, 42% were female, and 45% were non-Hispanic white. 353 patients (49%) received chemotherapy. In univariate analysis, receipt of chemotherapy was associated with age (53% for age < 65 years vs. 41% for age ≥ 65 years; p = 0.003) and insurance type (40% for no insurance vs 60% for private insurance; p = 0.0002), but was not associated with gender, race, or year of diagnosis. In a multivariate model, age (OR [< 65 years vs ≥ 65 years] 1.96; 95% CI, 1.26- 3.06; p = 0.003) and insurance type (OR [no insurance vs private insurance] 0.44; 95% CI 0.30-0.64; p < 0.0001) remained associated with receipt of chemotherapy. In multivariate analysis, gender (HR [female vs male] 0.85, 95% CI, 0.72-0.99; p = 0.04) and receipt of chemotherapy (HR [no chemo vs. chemo] 2.81; 95% CI, 2.38-3.31; p < 0.0001) were associated with overall survival. Conclusions: In a contemporary population representing the full age range of patients with stage IV NSCLC, chemotherapy was administered to nearly half of all patients—substantially more than in previous studies. Younger patients and insured patients were more likely to receive chemotherapy. Receipt of chemotherapy was associated with longer survival. These findings warrant further investigation. No significant financial relationships to disclose.