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Population Variations in the Initial Treatment of Non–Small-Cell Lung Cancer

From the Division of Cancer Control and Population Sciences, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD; and Department of Epidemiology, The University of Iowa, Iowa City, IA

Address reprint requests to Arnold L. Potosky, PhD, Applied Research Program, National Cancer Institute, 6130 Executive Blvd, EPN Room 4005, Bethesda, MD 20892; e-mail: potosky{at}nih.gov

PURPOSE: Dissemination of recommended therapies for non–small-cell lung cancer (NSCLC) have not been described comprehensively. We report the patterns of initial therapy focusing on the investigation of differences in receipt of recommended therapies according to multiple clinical and nonclinical patient characteristics.

METHODS: A population-based random sample of newly diagnosed NSCLC patients diagnosed in 10 separate geographic areas was collected in 1996 (n = 898). Data were obtained from medical records. Multiple logistic regression was used to assess the use of recommended therapies.

RESULTS: Overall, 52% of NSCLC patients received recommended therapy. Approximately 69%, 48%, and 41% of patients with stages I and II, III, or IV NSCLC received recommended therapy, respectively. For all stages combined, the use of recommended therapy was significantly inversely associated with age and stage at diagnosis. Recommended therapy also was more common in white versus black patients, and in married versus single patients. Stage-specific analyses revealed a significant decline in the use of recommended surgery with increasing age at diagnosis for early-stage NSCLC only, and a significantly lower use of recommended therapy (primarily chemoradiotherapy) for stage III black and Hispanic patients compared with white patients.

CONCLUSION: The overall use of recommended therapies for NSCLC is low. Large variations exist in the use of such therapies according to age, race or ethnicity, and marital status. Research combining medical record reviews with other sources of data is needed to better understand the contributions of both patient preferences and physician judgment to these treatment variations.

Supported by grant No. N01-PC-67005 to the Connecticut Department of Health, N01-PC-67006 to Emory University, N01-PC-67009 to Fred Hutchinson Cancer Research Center, N01-PC-65107 to Northern California Cancer Center, N01-PC-67008 to University of Iowa, N01-PC-67007 to Univeristy of New Mexico, N01-PC-67010 to University of Southern California, N01-PC-67000 to University of Utah, and N01-PC-65064 to Wayne State University from the National Cancer Institute, Division of Cancer Control and Population Sciences.

This study was made possible through the efforts of the Principal Investigators and the cancer registry personnel at the participating SEER registries.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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