title: Looking beyond surveillance, epidemiology, and end results: patterns of chemotherapy administration for advanced non-small cell lung cancer in a contemporary, diverse population.
abstract: BACKGROUND
  Chemotherapy prolongs survival without substantially impairing quality of life for medically fit patients with advanced non-small cell lung cancer (NSCLC), but population-based studies have shown that only 20 to 30% of these patients receive chemotherapy. These earlier studies have relied on Medicare-linked Surveillance, Epidemiology, and End Results (SEER) data, thus excluding the 30 to 35% of lung cancer patients younger than 65 years. Therefore, we determined the use of chemotherapy in a contemporary, diverse NSCLC population encompassing all patient ages.
  
  
  METHODS
  We performed a retrospective analysis of patients diagnosed with stage IV NSCLC from 2000 to 2007 at the University of Texas Southwestern Medical Center. Demographic, treatment, and outcome data were obtained from hospital tumor registries. The association between these variables was assessed using univariate analysis and multivariate logistic regression.
  
  
  RESULTS
  In all, 718 patients met criteria for analysis. Mean age was 60 years, 58% were men, and 45% were white. Three hundred fifty-three patients (49%) received chemotherapy. In univariate analysis, receipt of chemotherapy was associated with age (53% of patients younger than 65 years versus 41% of patients aged 65 years and older; p = 0.003) and insurance type (p < 0.001). In a multivariate model, age and insurance type remained associated with receipt of chemotherapy. For individuals receiving chemotherapy, median survival was 9.2 months, compared with 2.3 months for untreated patients (p < 0.001).
  
  
  CONCLUSIONS
  In a contemporary population representing the full age range of patients with advanced NSCLC, chemotherapy was administered to approximately half of all patients-more than twice the rate reported in some earlier studies. Patient age and insurance type are associated with receipt of chemotherapy.
authors.affiliation: Department of Internal Medicine (Hematology-Oncology), Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8852, USA.
authors.forename: Drew W
authors.initials: DW
authors.lastname: Rasco
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Dowell
authors.forename: David E
authors.initials: DE
authors.lastname: Gerber
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology