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Underutilization of Curative Treatment among Patients with Non Small Cell Lung Cancer: Experience from a Tertiary Care Centre in India

  • Malik, Prabhat Singh (Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Malik, Anita (Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Deo, Suryanarayana Venkata (Department of Surgical Oncoloy, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Mohan, Anant (Department of Pulmonary Medicine, All India Institute of Medical Sciences) ;
  • Mohanti, Bidhu Kalyan (Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Raina, Vinod (Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences)
  • Published : 2014.03.30

Abstract

Background: Lung cancer is one of the commonest and most lethal cancers throughout the world. The majority of the patients present at advance stage and are not suitable for curative intent treatment. Even among patients with localized disease, there has been underutilization of curative treatment modalities. The aim of this study was to analyze the radical treatment utilization rates in patients with non small cell lung cancer (NSCLC) treated at our centre. Materials and Methods: We analyzed case records of 104 patients with a pathologically confirmed diagnosis of NSCLC having stage 1-3B disease who were treated at our centre over last 3 years, to assess the utilization of curative treatment modalities i.e. surgery or radical radiotherapy. Results: The median age of this cohort was 58 years. Out of 104 patients only 33 (31.7%) received curative intent treatment, 14 undergoing curative resection and 19 receiving radical doses of radiotherapy. The baseline characteristics of both the groups (with or without radical treatment) were not different. Major factors associated with underutilization with curative treatment were progressive disease or loss of follow up after chemotherapy and inappropriate use of TKI and/or palliative radiotherapy in patients with stage 1-3B disease. Patients who did not receive radical treatment had inferior PFS and OS than those who received radical treatment. Conclusions: In our practice we observed gross underutilization of curative intent treatment modalities in patients with NSCLCs which is associated with inferior survival.

Keywords

References

  1. Crino L, Weder W, van Meerbeeck J, et al (2010). Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 21, 103-15. https://doi.org/10.1093/annonc/mdq207
  2. Cykert S, Dilworth-Anderson P, Monroe MH, et al (2010). Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA, 303, 2368-76. https://doi.org/10.1001/jama.2010.793
  3. Delaney G, Barton M, Jacob S, Jalaludin B (2003). A model for decision making for the use of radiotherapy in lung cancer. Lancet Oncol. 4, 120-8. https://doi.org/10.1016/S1470-2045(03)00984-7
  4. Delaney G, Jacob S, Featherstone C, Barton, M (2005). The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer, 104, 1129-37. https://doi.org/10.1002/cncr.21324
  5. Erridge SC, Murray B, Price A, et al (2008). Improved treatment and survival for lung cancer patients in South-East Scotland. J Thorac Oncol, 3, 491-8. https://doi.org/10.1097/JTO.0b013e31816fca46
  6. Ettinger DS (2012). NCCN Clinical Practice Guidelines in Oncology for Non Small Cell Lung Cancer, Ver 2.2012.
  7. Esnaola NF, Gebregziabher M, Knott K, et al (2008). Underuse of surgical resection for localized, non-small cell lung cancer among whites and African Americans in South Carolina. Ann Thorac Surg, 86, 220-6. https://doi.org/10.1016/j.athoracsur.2008.02.072
  8. Fry WA, Phillips JL, Menck HR (1999). Ten-year survey of lung cancer treatment and survival in hospitals in the United States: a national cancer data base report. Cancer, 86, 1867-76. https://doi.org/10.1002/(SICI)1097-0142(19991101)86:9<1867::AID-CNCR31>3.0.CO;2-9
  9. Mahmud SM, Reilly M, Comber H (2003). Patterns of initial management of lung cancer in the Republic of Ireland: a population-based observational study. Lung Cancer, 41, 57-64. https://doi.org/10.1016/S0169-5002(03)00148-X
  10. Parkin DM FJ, GLOBOCAN (2008). Cancer Incidence and Mortality Worldwide.
  11. Peters S, Adjei AA, Gridelli C, et al (2012). Metastatic nonsmall- cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 23, 56-64. https://doi.org/10.1093/annonc/mds089
  12. Stevens W, Stevens G, Kolbe J, Cox B (2007). Lung cancer in New Zealand: patterns of secondary care and implications for survival. J Thorac Oncol, 2, 481-93. https://doi.org/10.1097/JTO.0b013e31805fea3a
  13. Tyldesley S, Boyd C, Schulze K, Walker H, Mackillop WJ (2001). Estimating the need for radiotherapy for lung cancer: an evidence-based, epidemiologic approach. Int J Radiat Oncol Biol Phys, 49, 973-85. https://doi.org/10.1016/S0360-3016(00)01401-2
  14. Ustaalioglu BBO, Unal OU, Turan U , et al (2103) Prognostic factors for lymph node negative stage I and IIA non-small cell lung cancer: multicenter experiences. Asian Pac J Cancer Prev, 14, 6287-92
  15. Vinod SK, O'Connell DL, Simonella L, et al (2008). Gaps in optimal care for lung cancer. J Thorac Oncol, 3, 871-9. https://doi.org/10.1097/JTO.0b013e31818020c3
  16. Vinod SK, Sidhom MA, Gabriel GS, Lee MT, Delaney GP (2010). Why do some lung cancer patients receive no anticancer treatment? J Thorac Oncol, 5, 1025-32.

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