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Improvement in population‐based survival of stage IV NSCLC due to increased use of chemotherapy
Author(s) -
Aarts Mieke J.,
van den Borne Ben E.,
Biesma Bonne,
Kloover Jeroen S.,
Aerts Joachim G.,
Lemmens Valery E.P.P.
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29216
Subject(s) - medicine , hazard ratio , odds ratio , chemotherapy , population , adenocarcinoma , lung cancer , cancer , proportional hazards model , cancer registry , comorbidity , gastroenterology , oncology , surgery , confidence interval , environmental health
This study aimed to investigate which factors were associated with the administration of chemotherapy for patients with stage IV non‐small cell lung cancer (NSCLC), and their relation to survival at a population‐based level. All patients with NSCLC stage IV from 2001 to 2012 were identified in the Netherlands Cancer Registry in the Eindhoven area ( n = 5,428). Chemotherapy use and survival were evaluated by logistic and Cox regression analyses, respectively. The proportion of patients receiving chemotherapy increased from 30% in 2001 to 48% in 2012. Higher rates were found among younger patients [multivariable odds ratio (OR ≤64_ vs . _≥75_years ): 1.8 (95%CI 1.6–2.1)], high socioeconomic status [OR high_ vs ._low : 1.8 (95%CI 1.6–2.2)], no comorbidity [OR 0_ vs ._≥2 : 1.5 (95%CI 1.3–1.8)], diagnosed in recent years [OR 2010–2012_ vs ._2001–2003 : 2.0 (95%CI 1.6–2.3)] and adenocarcinoma [OR squamous_ vs ._adenocarcinoma : 0.8 (95%CI 0.6–0.9)]. Having liver metastasis was associated with reduced odds (OR liver_ vs . _brain : 0.8 (95%CI 0.7–1.0). The variation between hospitals was large, up to OR 2.0 (95%CI 1.5–2.6). Median survival increased from 18 weeks in 2001–2003 to 21 weeks in 2010–2012 (log‐rank p = 0.007), and was 35 weeks in patients with and 10 weeks without chemotherapy. The multivariable hazard of death reduced significantly over time [HR 2001–2003_ vs ._2010–2012 : 1.1 (95%CI 1.0–1.2), HR 2004–2005_ vs ._2010–2012 : 1.2 (95%CI 1.1–1.3)] and only remained significant for 2004–2006 after additional adjustment for chemotherapy [final multivariable model, HR 2004–2006_ vs ._2010–2012 : 1.1 (95%CI 1.0–1.2)]. Besides, prognostic factors were having chemotherapy [final multivariable model: HR 0.4 (95%CI 0.4–0.4)], female sex [HR male_ vs ._female : 1.1 (95%CI 1.0–1.1)], socioeconomic status [HR intermediate_and_high_ vs ._low both 0.9 (95%CI 0.9–1.0)], comorbidity [HR unknown_ vs ._≥2 : 1.3 (95%CI 1.2–1.5)], histology [HR other_ vs ._adenocarcinoma : 1.1 (95%CI 1.1–1.2)], and location of metastasis [range: 1.2 (HR lymph_nodes_ vs . _brain ) − 1.6 (HR liver_ vs ._brain )]. In conclusion, population‐based survival increased due to increasing administration rates of chemotherapy. The administration of chemotherapy was affected by hospital of diagnosis and both patient and tumour characteristics. Identifying patients who benefit from chemotherapy should become a key issue.