title: Treatment of small cell lung cancer in academic and community settings: factors associated with receiving standard therapy and survival.
abstract: OBJECTIVE
  Small cell lung cancer (SCLC) historically has had poor prognosis. Clinical trials have demonstrated improved survival among patients receiving standard platinum-/etoposide-based chemotherapy. Whereas treatment patterns and outcomes have been evaluated for patients with SCLC in clinical trials, population-based practice patterns are not well known.
  
  
  METHODS
  The National Cancer Institute's Patterns of Care study was used to evaluate patient and provider factors associated with standard treatment, clinical trial enrollment, and 12-month relative hazard of death.
  
  
  RESULTS
  Among 931 patients with SCLC diagnosed in 2007 in academic and community settings, 72.2% of patients with limited-stage (LS) disease received chemoradiation and 42.2% of patients with extensive-stage (ES) disease received chemotherapy only; the expected treatment scenarios by stage. Less than 1% of the patients enrolled in clinical trials and 2.1% of the patients with LS disease and 3.4% of the patients with ES disease refused any type of treatment. Patients 80 years or older at diagnosis and those with pneumonia/lung collapse were less likely to receive chemoradiation for LS disease. Patients treated in hospitals with residency programs were more likely to receive chemotherapy for ES disease, and patients 80 years or older were less likely to receive chemotherapy for ES disease. Finally, female patients with LS disease, black patients with ES disease, and all patients who received chemotherapy compared to receiving radiation alone or no therapy experienced significantly lower mortality.
  
  
  CONCLUSIONS
  Despite the demonstrated lower mortality, a relatively large proportion of patients with SCLC are not treated with a standard treatment regimen. Future studies should evaluate efforts to promote use of appropriate treatment regimens and encourage clinical trial participation.
authors.affiliation: From the *Applied Research Program, National Cancer Institute, Bethesda, MD; †Information Management Services, Inc, Calverton, MD; and ‡Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stevens
authors.forename: Claudio Dansky
authors.initials: CD
authors.lastname: Ullmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D059039:Standard of Care
chemical_list: D005047:Etoposide; D002945:Cisplatin