Patterns and Predictors of Chemotherapy Use for Resected Non-Small Cell Lung Cancer.
BACKGROUND
Chemotherapy combined with surgical resection improves survival in patients with stage II to IIIA non-small cell lung cancer (NSCLC) and may benefit selected patients with stage IB disease. We sought to evaluate chemotherapy use in resected stage IB to IIIA NSCLC over time and to identify predictors of perioperative chemotherapy administration.


METHODS
Patients with resected stage IB to IIIA NSCLC were identified from the National Cancer Data Base (2002 to 2011). Administration of chemotherapy was assessed over time. Hierarchical regression models were developed to assess patient, hospital, and tumor-level characteristics predicting perioperative chemotherapy administration.


RESULTS
In 55,016 stage IB patients, chemotherapy use significantly increased between 2002 and 2011 from 5.3% to 15.1% (p < 0.001). In 57,033 patients with stage II to IIIA disease, perioperative chemotherapy administration also significantly increased from 29.3% to 58.4% (p < 0.001). Multivariable analyses demonstrated stage IB and II to IIIA patients were less likely to receive chemotherapy if they were older, treated at an academic center (vs community), had more comorbidities, or had lower-grade tumors (all p < 0.05). Stage IB patients with tumors sized 4 cm or larger were more likely to receive chemotherapy (odds ratio, 3.16; 95% confidence interval, 2.73 to 3.65) than those with tumors smaller than 4 cm. Compared with stage IIA patients, stage IIB patients were no more likely to receive perioperative chemotherapy (odds ratio, 1.06; 95% confidence interval, 0.96 to 1.17), whereas stage IIIA patients received chemotherapy significantly more often (odds ratio, 2.82; 95% confidence interval, 2.55 to 3.11).


CONCLUSIONS
The use of chemotherapy has significantly increased in patients with resected stage IB to IIIA NSCLC. Although clinicians have increasingly adopted evidence-based recommendations, significant treatment gaps persist and represent areas for quality improvement.
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: rrajaram@facs.org.
Ravi
R
Rajaram
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
Jennifer L
JL
Paruch
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
Sanjay
S
Mohanty
Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Jane L
JL
Holl
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Karl Y
KY
Bilimoria
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
Clifford Y
CY
Ko
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
David P
DP
Winchester
Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
Jyoti D
JD
Patel
Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Malcolm M
MM
DeCamp
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents