Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?
- Resource Type
- Authors
- Lynne Chepulis; Karen Middleton; Lucia Moosa; Charles de Groot; Denise Aitken; Leonie Brown; Chunhuan Lao; Paul Conaglen; Janice Wong; Jacquie Kidd; Ross Lawrenson; Rawiri Keenan
- Source
- BMC Cancer, Vol 20, Iss 1, Pp 1-9 (2020)
BMC Cancer
- Subject
- Adult
Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
medicine.medical_treatment
Comorbidity
lcsh:RC254-282
Health Services Accessibility
03 medical and health sciences
0302 clinical medicine
Non-small cell lung cancer
Internal medicine
Stereotactic ablative body radiotherapy
Genetics
medicine
Humans
030212 general & internal medicine
Lung cancer
Aged
Neoplasm Staging
Proportional Hazards Models
Aged, 80 and over
Chemotherapy
business.industry
Proportional hazards model
Hazard ratio
Smoking
Cancer
Disease Management
Odds ratio
Middle Aged
Patient Acceptance of Health Care
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Radiation therapy
Thoracic surgery
Oncology
Cardiothoracic surgery
030220 oncology & carcinogenesis
Female
business
Research Article
- Language
- English
- ISSN
- 1471-2407
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.