title: Prior cancer does not adversely affect survival in locally advanced lung cancer: A national SEER-medicare analysis.
abstract: Management of locally advanced non-small cell lung cancer is among the most highly contested areas in thoracic oncology. In this population, a history of prior cancer frequently results in exclusion from clinical trials and may influence therapeutic decisions. We therefore determined prevalence and prognostic impact of prior cancer among these patients.
  
  
  
  We identified patients>65years of age diagnosed 1992-2009 with locally advanced lung cancer in the Surveillance, Epidemiology, and End Results-Medicare linked dataset. We characterized prior cancer by prevalence, type, stage, and timing. We compared all-cause and lung cancer-specific survival between patients with and without prior cancer using propensity score-adjusted Cox regression.
  
  
  
  51,542 locally advanced lung cancer patients were included; 15.8% had a history of prior cancer. Prostate (25%), gastrointestinal (17%), breast (16%), and other genitourinary (15%) were the most common types of prior cancer, and 76% percent of prior cancers were localized or in situ stage. Approximately half (54%) of prior cancers were diagnosed within 5 years of the index lung cancer date. Patients with prior cancer had similar (propensity-score adjusted hazard ratio [HR] 0.96; 95% CI, 0.94-0.99; P=0.005) and improved lung cancer-specific (HR 0.84; 95% CI, 0.81-0.86; P<0.001) survival compared to patients with no prior cancer.
  
  
  
  For patients with locally advanced lung cancer, prior cancer does not adversely impact clinical outcomes. Patients with locally advanced lung cancer and a history of prior cancer should not be excluded from clinical trials, and should be offered aggressive, potentially curative therapies if otherwise appropriate.
authors.affiliation: Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Laccetti
authors.affiliation: Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, United States; Harold C. Simmons Comprehensive Cancer Center, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.affiliation: Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Lei
authors.initials: L
authors.lastname: Xuan
authors.affiliation: Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States; Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, United States; Harold C. Simmons Comprehensive Cancer Center, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: Department of Internal Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, United States; Harold C. Simmons Comprehensive Cancer Center, University of Texas, Southwestern Medical Center, Dallas, TX, United States. Electronic address: david.gerber@utsouthwestern.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Gerber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Clinical trial design; Lung cancer; Prior malignancy; Survival