TY - JOUR
T1 - Trends, predictors, and impact of systemic chemotherapy in small cell lung cancer patients between 1985 and 2005
AU - Behera, Madhusmita
AU - Ragin, Camille
AU - Kim, Sungjin
AU - Pillai, Rathi N.
AU - Chen, Zhengjia
AU - Steuer, Conor E.
AU - Saba, Nabil F.
AU - Belani, Chandra P.
AU - Khuri, Fadlo R.
AU - Ramalingam, Suresh S.
AU - Owonikoko, Taofeek K.
N1 - Funding Information:
This work was supported in part by National Cancer Institute (1K23CA164015) and Georgia Cancer Coalition awards to Taofeek K. Owonikoko and by the Biostatistics and Bioinformatics Shared Resource of the Winship Cancer Institute (Emory University) through a National Institutes of Health/National Cancer Institute award (P30CA138292). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; by the National Cancer Institute''s Surveillance, Epidemiology, and End Results program under contract N01-PC-35136 awarded to the Northern California Cancer Center, under contract N01-PC-35139 awarded to the University of Southern California, and under contract N02-PC-15105 awarded to the Public Health Institute; and by the Centers for Disease Control and Prevention''s National Program of Cancer Registries under agreement U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. Suresh S. Ramalingam has been on advisory boards for and received honoraria from AstraZeneca, AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Novartis, Lilly, Genentech, and Merck.
Publisher Copyright:
© 2015 American Cancer Society.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - BACKGROUND The last 3 decades have witnessed limited therapeutic advances in small cell lung cancer (SCLC) management. This study evaluated real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to find patients diagnosed with SCLC between 1985 and 2005. The 1985-1990 period served as the baseline for a temporal analysis conducted at 5-year intervals (1985-1990, 1991-1995, 1996-2000, and 2001-2005). Cox proportional models were used to estimate the effect of chemotherapy on survival. Results were validated with a propensity-matched analysis. RESULTS There were 47,351 eligible patients: 52% were male; the median age was 71 years; and 87% were white, 7% were black, and 1.4% were Asian. The proportion of patients treated with chemotherapy was low but increased over time (38%, 55%, 50%, and 53%; P <.001). Race, diagnosis period, age, stage, and location of residence significantly predicted chemotherapy use. Females (51%), Asians (53%), and rural residents (60%) were more likely to receive chemotherapy. The median overall survival with and without chemotherapy was 9.6 and 3.6 months, respectively. Linear trend analyses showed a modest reduction in the impact of chemotherapy on survival for patients treated with chemotherapy versus untreated patients (hazard ratios [HRs], 0.59, 0.61, 0.64, and 0.62; P <.001) but an overall trend of improved survival for treated (HRs, 1.0, 1.03, 1.00, and 0.96; P =.005) and untreated patients (HRs, 1.0, 0.99, 0.94, and 0.92; P <.001). There was no survival difference between patients treated with carboplatin and patients treated with cisplatin (HR, 0.99; confidence interval [CI], 0.81-1.19; P =.875). Additional therapy beyond platinum-based chemotherapy was associated with a survival benefit (HR, 0.78; CI, 0.75-0.81; P <.001). CONCLUSIONS Chemotherapy use was associated with a survival benefit in Medicare patients with SCLC treated in a real-world setting. Cancer 2016;122:50-60. This study evaluates real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. Chemotherapy use is associated with a survival benefit in US Medicare-eligible patients with small cell lung cancer treated in a real-world setting.
AB - BACKGROUND The last 3 decades have witnessed limited therapeutic advances in small cell lung cancer (SCLC) management. This study evaluated real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to find patients diagnosed with SCLC between 1985 and 2005. The 1985-1990 period served as the baseline for a temporal analysis conducted at 5-year intervals (1985-1990, 1991-1995, 1996-2000, and 2001-2005). Cox proportional models were used to estimate the effect of chemotherapy on survival. Results were validated with a propensity-matched analysis. RESULTS There were 47,351 eligible patients: 52% were male; the median age was 71 years; and 87% were white, 7% were black, and 1.4% were Asian. The proportion of patients treated with chemotherapy was low but increased over time (38%, 55%, 50%, and 53%; P <.001). Race, diagnosis period, age, stage, and location of residence significantly predicted chemotherapy use. Females (51%), Asians (53%), and rural residents (60%) were more likely to receive chemotherapy. The median overall survival with and without chemotherapy was 9.6 and 3.6 months, respectively. Linear trend analyses showed a modest reduction in the impact of chemotherapy on survival for patients treated with chemotherapy versus untreated patients (hazard ratios [HRs], 0.59, 0.61, 0.64, and 0.62; P <.001) but an overall trend of improved survival for treated (HRs, 1.0, 1.03, 1.00, and 0.96; P =.005) and untreated patients (HRs, 1.0, 0.99, 0.94, and 0.92; P <.001). There was no survival difference between patients treated with carboplatin and patients treated with cisplatin (HR, 0.99; confidence interval [CI], 0.81-1.19; P =.875). Additional therapy beyond platinum-based chemotherapy was associated with a survival benefit (HR, 0.78; CI, 0.75-0.81; P <.001). CONCLUSIONS Chemotherapy use was associated with a survival benefit in Medicare patients with SCLC treated in a real-world setting. Cancer 2016;122:50-60. This study evaluates real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. Chemotherapy use is associated with a survival benefit in US Medicare-eligible patients with small cell lung cancer treated in a real-world setting.
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U2 - 10.1002/cncr.29674
DO - 10.1002/cncr.29674
M3 - Article
C2 - 26441041
AN - SCOPUS:84947998924
SN - 0008-543X
VL - 122
SP - 50
EP - 60
JO - Cancer
JF - Cancer
IS - 1
ER -
