Treatment, no treatment and early death in Danish stage I lung cancer patients

Christensen, N. E.; Dalton, Susanne Oksbjerg; Ravn, Jesper; Christensen, Jane; Jakobsen, Erik; Rasmussen, Torben Riis

doi:10.1016/j.lungcan.2019.03.007

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Other reasons included cancer stage -(stage II cases were less likely to be treated curatively than stage I), cancer cell type (small cell tumours were less likely to be treated than NSCLC), and those with COPD or poor respiratory function who were less likely to receive surgery or curative treatment as were those with a poor ECOG status. These findings are similar to the findings from a Danish study [16] of stage I lung cancer and the historical New Zealand study [7]. SCLC proliferates more rapidly and has a high propensity to metastasise.…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 88%

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

et al. 2020

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“…The cause of death among early death patients has been reported earlier [21]. Furthermore, patients with no treatment registration in the DLCR have been assessed in another study [22]. It is beyond the scope of this article to discuss each association individually, although we have reported a number of important findings in terms of individual comorbidities (atrial fibrillation and valvulopathy), which were individually associated with early death, even though these diseases are not included in the CCI.…”

Section: Discussionmentioning

confidence: 97%

Comorbidity and early death in Danish stage I lung cancer patients – an individualised approach

et al. 2020

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Background: Comorbidity is an important prognostic marker and a treatment indicator for lung cancer patients. Register-based studies often describe the burden of comorbidity by the Charlson comorbidity index (CCI) based on hospital discharge data. We assessed the association between somatic and psychiatric comorbidity and death within one year in early lung cancer and, furthermore, the burden of comorbidity according to treatment type. Material and methods: We conducted a population-based matched case-control study of stage I lung cancer identifying all treated patients who died (all-cause) within one year after diagnosis (early death group, cases). On the basis of data from the Danish Lung Cancer Registry these patients were then matched with two controls who survived more than one year (survivors). Through a review of the medical records, we validated inclusion criteria and collected data on somatic and psychiatric comorbidity. We assessed the association between comorbidity and early death with multivariate conditional logistic regression. Results: We included 221 cases and 410 controls. The mean CCI score in the early death group was 2.3 vs. 1.3 in the survivor group (p < .001). Still, 22% vs. 30% had a CCI score of zero (p ¼ .04) with an average number of comorbidities among these patients of 1.63 vs. 1.06 respectively (p ¼ .006). Among women, 23% in the early death group had depression vs. 13% in the survivor group, corresponding to an unadjusted odds ratio (OR) of 2.0 (CI 95% 1.0-3.7). However, in an adjusted analysis (incl. somatic comorbidities) the OR was 1.7 (CI 95% 0.8-3.5). Patients undergoing oncological therapy were older and tended to have more somatic comorbidities than the surgically treated patients. Conclusion: Comorbidity remains a significant prognostic marker even for stage I lung cancer patients with a CCI score of zero. The suggested association between early death and depression among women needs to be studied further.

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“…There are other powerful and healing therapies available. However, some patients only receive palliative treatment, while others get no treatment at all [ 25 ]. According to the search [ 25 ], comorbidities, patient preferences, and illness progression are the main causes of treatment refusal.…”

Section: Discussionmentioning

confidence: 99%

“…However, some patients only receive palliative treatment, while others get no treatment at all [ 25 ]. According to the search [ 25 ], comorbidities, patient preferences, and illness progression are the main causes of treatment refusal. Therefore, in addition to the previously mentioned reasons in this study, the impact of comorbidities, patient decisions, disease progression, patients' financial ability, and acceptance of doctors and techniques on whether advanced NSCLC patients refuse recommended surgery is thus poorly understood and requires further research.…”

Section: Discussionmentioning

confidence: 99%

Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery

Wang

Yang

Liu

et al. 2023

Canadian Respiratory Journal

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Background. There is currently limited evidence for a correlation between the recommended operation and overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC). Methods. NSCLC patients with stages III and IV, recommended for operation, were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER).We used propensity score matching (PSM) and multivariable Cox proportional hazards regression to ensure the robustness of our findings. The cumulative rates of death were compared between patients with and without recommended operations using the Kaplan−Meier curves. Results. Operation was recommended for 3331 patients but was not performed in 912 (27.4%) patients (then on-operative group). After PSM, 553 pairs matched. Compared to the nonoperative group, the hazard ratios (HRs) in the operative group were 0.46 (95% CI 0.23–0.95 and p = 0.037 ) in stage IIIA and 0.54 (95% CI 0.42–0.68 and p < 0.001 ) in stage IVA. However, in stages IIIB, IIIC, and IVB, the recommended operative group was not associated with better OS. The OS was not different in stage IIIA-N2, stage IVA-N1, and stage IVA-N3 patients between groups ( p = 0.28 , p = 0.14 , and p = 0.79 , respectively). Moreover, the recommended operative group had better OS than the nonoperative group in stage IIIA-N0 ( p = 0.00085 ), stage IIIA-N1 ( p = 0.009 ), stage IVA-N0 ( p < 0.001 ), and stage IVA-N2 ( p = 0.034 ). Conclusion. Compared to the nonoperative group, recommended operation improved survival in NSCLC patients with stage IIIA-N0, stage IIIA-N1, stage IVA-N0, and stage IVA-N2. However, in stages IIIA-N2, IIIB, IIIC, IVA-N1, IVA-N3, and IVB, recommended operation did not lead to significantly improved survival time.

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Treatment, no treatment and early death in Danish stage I lung cancer patients

Cited by 8 publications

References 29 publications

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

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

Comorbidity and early death in Danish stage I lung cancer patients – an individualised approach

Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery

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