Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

Abstract

Backgrounds: This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods: Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results: In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent-272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8-91.8%) and 5-year survival of 69.6% (95% CI: 63.2-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions: The majority of patients with stage I and II lung cancer are managed with potentially curative treatment mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

An International Consensus on Actions to Improve Lung Cancer Survival: A Modified Delphi Method Among Clinical Experts in the International Cancer Benchmarking Partnership

“… 15 Variation in the use of curative intent therapies within early stage patients has been demonstrated in some countries. 16 Disease stage, patient fitness/performance status, lung function, staffing skillset, socioeconomic status and comorbidities play key influential roles in the perceived operability of patients and subsequent treatment decisions. 16 …”

“… 16 Disease stage, patient fitness/performance status, lung function, staffing skillset, socioeconomic status and comorbidities play key influential roles in the perceived operability of patients and subsequent treatment decisions. 16 …”

“…16 Disease stage, patient fitness/performance status, lung function, staffing skillset, socioeconomic status and comorbidities play key influential roles in the perceived operability of patients and subsequent treatment decisions. 16 The organisation of each country's healthcare system has been established to guide patients from presentation to the decision for treatment, with many informal and formal treatment pathways being established. However, gaps and biases within each system have been identified that undoubtedly affect the management of potentially curable patients.…”

“…15 Variation in the use of curative intent therapies within early stage patients has been demonstrated in some countries. 16 Disease stage, patient fitness/performance status, lung function, staffing skillset, socioeconomic status and comorbidities play key influential roles in the perceived operability of patients and subsequent treatment decisions. 16 The organisation of each country's healthcare system has been established to guide patients from presentation to the decision for treatment, with many informal and formal treatment pathways being established.…”

Sophoridine Inhibits the Tumour Growth of Non-Small Lung Cancer by Inducing Macrophages M1 Polarisation via MAPK-Mediated Inflammatory Pathway

“…The high mortality rate of NSCLC is mainly responsible for the difficulty of early detection for prognosis, high risk of metastasis, and inadequate reactions to chemical therapy and radiotherapy ( 3 ). Since no curative therapy has been developed to date for the developed lung cancer, clinical care is mostly palliative ( 4 ). It is therefore necessary to gain deep insight into the fundamental biological and molecular mechanisms of the progression of NSCLC.…”