The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications

Stavas, Mark J.; Arneson, Kyle O.; Ning, Matthew S.; Attia, Albert; Phillips, Sharon; Perkins, Stephanie M.; Shinohara, Eric T.

doi:10.1016/j.jpainsymman.2014.11.298

Cited by 17 publications

(30 citation statements)

References 36 publications

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“…18,19 In the US, 3% of patients, primarily elderly, non-black/non-white, and unmarried female patients refuse palliative radiation for metastatic NSCLC. 28 In our study, the mean age difference between the TG and NTG was nine years. Lung cancer occurs mainly in elderly patients and mortality increases with age, 29 particularly in Asian and Caucasian populations.…”

Section: Discussionmentioning

confidence: 46%

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Risk factors associated with treatment refusal in lung cancer

et al. 2017

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BackgroundThe incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer.MethodsWe retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti‐cancer treatment and allowed only palliative care were classified into the non‐treatment group, while the remaining 468 who received anti‐cancer treatment were classified into the treatment group.ResultsThe groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage (P < 0.05). In logistic regression analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.07–1.13), educational status lower than high school (OR 1.95, 95% CI 1.2–3.2), no history of surgery (OR 2.29, 95% CI 1.4–3.7), body mass index < 18.5 (OR 2.49, 95% CI 1.3–4.7), and a high Eastern Cooperative Oncology Group score of 3 or 4 (OR 5.02, 95% CI 2.3–10.8) were significant factors for refusal of cancer treatment.ConclusionIndividual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients.

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Section: Discussionmentioning

confidence: 46%

“…In colorectal cancer patients, the treatment refusal group was on average 4.6 years older than the treated group . In the US, 3% of patients, primarily elderly, non‐black/non‐white, and unmarried female patients refuse palliative radiation for metastatic NSCLC . In our study, the mean age difference between the TG and NTG was nine years.…”

Section: Discussionmentioning

confidence: 56%

Risk factors associated with treatment refusal in lung cancer

et al. 2017

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“…Controlling the primary tumor was found to prolong patient survival and may lead to long‐term survival of patients with stage IV NSCLC . Refusing palliative RT led to poor survival . Both the 2011 American Society for Radiation Oncology (ASTRO) Guideline and the 2014 European Society for Medical Oncology (ESMO) Guideline concluded that RT plays a major role in controlling the symptoms of metastases, such as painful chest wall disease, superior vena cava syndrome, soft tissue, or neural invasion.…”

Section: Discussionmentioning

confidence: 99%

“…34,35 Refusing palliative RT led to poor survival. 36 Both the 2011 American Society for Radiation Oncology (ASTRO) Guideline and the 2014 European Society for Medical Oncology (ESMO) Guideline concluded that RT plays a major role in controlling the symptoms of metastases, such as painful chest wall disease, superior vena cava syndrome, soft tissue, or neural invasion. Therefore, there is no doubt that palliative TRT plays an important role in metastatic lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy improves the survival of patients with stage IV NSCLC: A propensity score matched analysis of the SEER database

Zhang

et al. 2018

Cancer Medicine

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ObjectivesThe survival advantage of radiotherapy (RT) for patients with stage IV non‐small cell lung cancer (NSCLC) has not been adequately evaluated.MethodsWe analyzed stage IV NSCLC patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) registry through January 2010 to December 2012. Propensity score (PS) analysis with 1:1 nearest neighbor matching method was used to ensure well‐balanced characteristics of all comparison groups by histological types and metastatic sites. Kaplan‐Meier and Cox proportional hazardous model were used to evaluate the overall survival (OS), cancer‐specific survival (CSS), and corresponding 95% confidence interval (95%CI).ResultsGenerally speaking, there was a trend toward improved OS and CSS for using RT to stage IV NSCLC patients for any metastatic sites and for any histological types except adenocarcinoma (AD). Radiotherapy significantly improved the survival of NSCLC patients with metastasis to brain (P < 0.001), especially for AD (P < 0.001). For stage IV lung cancer patients with squamous cell carcinoma (SQC), RT for any metastatic sites could universally improve the OS (P < 0.001) and CSS (P < 0.001). In particular, RT was also associated with improving OS (P < 0.001) and CSS (P = 0.012) for stage IV patients with metastases of two or more sites, ie, polymetastatic disease. Furthermore, for those stage IV SQC patients without metastasis, RT, most likely to the primary site, also significantly improved the survival (P < 0.001).ConclusionsThe results support that RT might improve the survival of patients with metastatic NSCLC in a PS‐matched patient cohort from the large SEER database. It is prudent to carefully select patients for RT in metastatic NSCLC.

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“…Stereotactic body radiotherapy (SBRT) has been shown to be safe and efficacious in patients with oligometastatic lung cancer in a variety of additional anatomic locations (8,(24)(25)(26). Further, a previous study of the SEER database showed that patients refusing palliative RT for metastatic NSCLC had diminished OS relative to those not refusing RT (27).…”

Section: Discussionmentioning

confidence: 99%