title: Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study.
abstract: Older patients with non-small cell lung cancer (NSCLC) are less likely to receive guideline-recommended treatment at diagnosis, independent of comorbidity. However, national data on treatment of postoperative recurrence are limited. We evaluated the associations between age, comorbidity, and other patient factors and treatment of postoperative NSCLC recurrence in a national cohort.
  
  
  
  We randomly selected 9001 patients with surgically resected stage I-III NSCLC in 2006-2007 from the National Cancer Data Base. Patients were followed for 5 years or until first NSCLC recurrence, new primary cancer, or death, whichever came first. Perioperative comorbidities, first recurrence, treatment of recurrence, and survival were abstracted from medical records and merged with existing registry data. Factors associated with active treatment (chemotherapy, radiation, and/or surgery) versus supportive care only were analyzed using multivariable logistic regression.
  
  
  
  Median age at initial diagnosis was 67; 69.7% had >1 comorbidity. At 5-year follow-up, 12.3% developed locoregional and 21.5% developed distant recurrence. Among patients with locoregional recurrence, 79.5% received active treatment. Older patients (OR 0.49 for age >75 compared with <55; 95% CI 0.27-0.88) and those with substance abuse (OR 0.43; 95% CI 0.23-0.81) were less likely to receive active treatment. Women (OR 0.62; 95% CI 0.43-0.89) and patients with symptomatic recurrence (OR 0.69; 95% CI 0.47-0.99) were also less likely to receive active treatment. Among those with distant recurrence, 77.3% received active treatment. Older patients (OR 0.42 for age >75 compared with <55; 95% CI 0.26-0.68) and those with any documented comorbidities (OR 0.59; 95% CI 0.38-0.89) were less likely to receive active treatment.
  
  
  
  Older patients independent of comorbidity, patients with substance abuse, and women were less likely to receive active treatment for postoperative NSCLC recurrence. Studies to further characterize these disparities in treatment of NSCLC recurrence are needed to identify barriers to treatment.
authors.affiliation: Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 505 Parnassus Ave., Mailbox 1270, San Francisco, CA 94143, USA. Electronic address: melisa.wong@ucsf.edu.
authors.forename: Melisa L
authors.initials: ML
authors.lastname: Wong
authors.affiliation: Department of Public Health Sciences, University of Virginia Health System, PO Box 800717, Charlottesville, VA 22908-0717, USA. Electronic address: tlm6w@eservices.virginia.edu.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McMurry
authors.affiliation: Department of Public Health Sciences, University of Virginia Health System, PO Box 800717, Charlottesville, VA 22908-0717, USA. Electronic address: gjs6r@eservices.virginia.edu.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL 60611, USA. Electronic address: afrancescatti@facs.org.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Francescatti
authors.affiliation: Alliance for Clinical Trials in Oncology, 125 S. Wacker Drive, Suite 1600, Chicago, IL 60606, USA. Electronic address: cmartz@alliancefoundationtrials.org.
authors.forename: Carla
authors.initials: C
authors.lastname: Amato-Martz
authors.affiliation: Department of Surgery, University of Wisconsin, 600 Highland Ave., BX7375 Clinical Science Center, Madison, WI 53792-3284, USA. Electronic address: schumacher@surgery.wisc.edu.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.affiliation: Departments of Surgical Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 444, Houston, TX 77030, USA. Electronic address: GChang@mdanderson.org.
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of Wisconsin, 600 Highland Ave., BX7375 Clinical Science Center, Madison, WI 53792-3284, USA. Electronic address: greenberg@surgery.wisc.edu.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Cancer Programs, American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL 60611, USA. Electronic address: DWinchester@facs.org.
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.affiliation: Commission on Cancer, American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL 60611, USA. Electronic address: d.mckellar1958@gmail.com.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: McKellar
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, 4150 Clement (181G), San Francisco, CA 94121, USA. Electronic address: Louise.Walter@ucsf.edu.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Washington University, One Barnes-Jewish Hospital Plaza, Suite 3108, Queeny Tower, St. Louis, MO 63110-1013, USA. Electronic address: kozowerb@wudosis.wustl.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D016019:Survival Analysis
keywords: Geriatric oncology; Non-small cell lung cancer; Recurrence; Treatment