Compliance with adjuvant chemotherapy in non-small cell lung cancer. The experience of a single institution evaluating a cohort of 356 patients.
OBJECTIVE
To evaluate the patient compliance with adjuvant chemotherapy (CT) following radical surgery for non-small cell lung cancer (NSCLC), and to identify the potential confounding factors affecting this particular aspect.


METHODS
We retrospectively evaluated a series of 356 consecutively treated NSCLC patients at a single institution during 1994-2003. All patients had macroscopic and microscopic radical resection of the primary tumor, with or without mediastinal node dissection or sampling, had received at least one adjuvant CT cycle, with or without postoperative irradiation (RT). CT was planned to be believed for 6 cycles. The following schedules were used: cisplatin (CDDP) 60 mg/m(2), cyclophosphamide 600 mg/m(2) and epirubicin 60 mg/m(2) on day 1 every 21 days (16%);etoposide 120 mg/m(2) and CDDP 30 mg/m(2), on days 1-3, every 21 days (68%); other platinum-based doublets (16%). A multivariate analysis, for a target of 4 and 6 cycles was performed in order to evaluate the potential impact on the patient compliance of the following categories: age, sex (male vs. female), extent of surgery (pneumectomy vs. lesser resection), stage (I,II vs. III), RT(delivered or not) and patient residence (local vs. remote).


RESULTS
One hundred and seventy-nine (50%) patients completed all 6 cycles, while 299 (84%) received at least 4 cycles. The median number of administered cycles was 5. For a target of 4 cycles none of the investigated variables had any significant impact. A significant impact on compliance for 6 cycles was recorded for age (OR 0.97, 95% CI 0.95-0.99, p=0.01) and extent of surgery (OR 0.54, 95% CI 0.33-0.87, p=0.01)


CONCLUSIONS
Using the above mentioned combinations, the patient compliance with adjuvant CT was good, with 84% receiving at least 4 and 50% all 6 cycles. The median number of cycles was 5. For a target of 4 cycles none of the investigated variables had a significant impact. For a longer CT duration, age and extent of surgery were correlated with a lower compliance.
Dediu
M
M
Medical Oncology Department, Institute of Oncology Bucharest, Bucharest, Romania. mdediu@dnt.ro
Alexandru
A
A
Median
D
D
Anghel
R
R
Tarlea
A
A
Iorga
P
P
Movanu
M
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010349:Patient Compliance; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome