title: Temporal patterns of care and outcomes of non-small cell lung cancer patients in the United States diagnosed in 1996, 2005, and 2010.
abstract: Lung cancer remains a common and deadly cancer in the United States. This study evaluated factors associated with stage-specific cancer therapy and survival focusing on temporal trends and sociodemographic disparities.
  
  
  
  A random sample (n=3,318) of non-small cell lung cancer (NSCLC) patients diagnosed in 1996, 2005 and 2010, and reported to the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program was analyzed. Logistic regression was utilized to identify factors associated with receipt of surgery among stage I/II patients and chemotherapy among stage IIIB/IV patients. Cox proportional hazard regression was utilized to assess factors associated with all-cause mortality, stratified by stage.
  
  
  
  Surgery among stage I/II patients decreased non-significantly overtime (1996: 78.8%; 2010: 68.5%; p=0.18), whereas receipt of chemotherapy among stage IIIB/IV patients increased significantly overtime (1996: 36.1%; 2010: 51.2%; p<0.01). Receipt of surgery (70-79 and ≥80 vs. <70: Odds Ratio(OR):0.31; 95% Confidence Interval (CI): 0.16-0.63 and OR:0.04; 95% CI: 0.02-0.10, respectively) and chemotherapy (≥80 vs. <70: OR: 0.26; 95% CI:0.15-0.45) was less likely among older patients. Median survival improved non-significantly among stage I/II patients from 51 to 64 months (p=0.75) and significantly among IIIB/IV patients from 4 to 5 months (p<0.01).
  
  
  
  Treatment disparities were observed in both stage groups, notably among older patients. Among stage I/II patients, survival did not change significantly possibly due to stable surgery utilization. Among stage IIIB/IV patients, although the use of chemotherapy increased and survival improved, the one-month increase in median survival highlights the need for addition research.
authors.affiliation: National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States.
authors.forename: Filip
authors.initials: F
authors.lastname: Kaniski
authors.affiliation: National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States. Electronic address: lindsey.enewold@nih.gov.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Enewold
authors.affiliation: National Cancer Institute, Center for Cancer Research, Thoracic and Gastrointestinal Oncology Branch, United States.
authors.forename: Anish
authors.initials: A
authors.lastname: Thomas
authors.affiliation: National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, United States, United States.
authors.forename: Shakuntala
authors.initials: S
authors.lastname: Malik
authors.affiliation: Information Management Services, Inc., United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stevens
authors.affiliation: National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D018426:SEER Program / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Chemotherapy; Lung cancer; Radiation; Surgery; Targeted therapy survival; Treatment