title: Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity.
abstract: BACKGROUND
  Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices.
  
  
  METHODS
  We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations.
  
  
  RESULTS
  Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations.
  
  
  CONCLUSIONS
  Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.
authors.affiliation: Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. srogers@partners.org
authors.forename: Selwyn O
authors.initials: SO
authors.lastname: Rogers
authors.forename: Stacy W
authors.initials: SW
authors.lastname: Gray
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fletcher
authors.forename: Steven
authors.initials: S
authors.lastname: Clauser
authors.forename: Diana
authors.initials: D
authors.lastname: Tisnado
authors.forename: William
authors.initials: W
authors.lastname: Doucette
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000328:Adult; D000367:Age Factors; D000465:Algorithms; D001900:Boston / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000706:statistics & numerical data