Treatment and outcomes of non-small-cell lung cancer patients with high comorbidity
Authors Rios J, Gosain R, Goulart BHL, Huang B, Oechsli MN, McDowell JK, Chen Q, Tucker T, Kloecker GH
Received 18 September 2017
Accepted for publication 27 November 2017
Published 24 January 2018 Volume 2018:10 Pages 167—175
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Kenan Onel
Jorge Rios,1 Rahul Gosain,1 Bernardo HL Goulart,2 Bin Huang,3 Margaret N Oechsli,1 Jaclyn K McDowell,4 Quan Chen,4 Thomas Tucker,4 Goetz H Kloecker1
1James Graham Brown Cancer Center, University of Louisville, Louisville, KY, 2Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, 3Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, 4Markey Cancer Center, University of Kentucky, Lexington, KY, USA
Background: The life expectancy of untreated non-small-cell lung cancer (NSCLC) is dismal, while treatment for NSCLC improves survival. The presence of comorbidities is thought to play a significant role in the decision to treat or not treat a given patient. We aim to evaluate the association of comorbidities with the survival of patients treated for NSCLC.
Methods: We performed a retrospective study of patients aged ≥66 years with invasive NSCLC between the years 2007 and 2011 in the Surveillance, Epidemiology, and End Results Kentucky Cancer Registry. Comorbidity was measured using the Klabunde Comorbidity Index (KCI), and univariate and multivariate logistic regression models were used to measure association between receiving treatment and comorbidity. Kaplan–Meier plots were constructed to estimate time-to-event outcomes.
Results: A total of 4014 patients were identified; of this, 94.9% were white and 55.7% were male. The proportion of patients who did not receive any treatment was 8.7%, 3.9%, 19.1%, and 23.5% for stages I, II, III, and IV, respectively (p<0.0001). In multivariate analysis, older age, higher stage, and higher comorbidity (KCI ≥3) were associated with a lower likelihood of receiving any treatment. The median overall survival (OS) for untreated and KCI=0 was 17.7 months for stages I and II, 2.3 months for stage III, and 1.3 months for stage IV. The median OS for treated and KCI=0 was 58.9 months for stages I and II, 16.8 months for stage III, and 5.8 months for stage IV (p<0.01). Treatment was an independent predictor of OS in multivariate analysis that included KCI scores.
Conclusion: Our data suggest that lung cancer patients may derive a survival benefit from therapies, regardless of the presence of comorbidities, although the degree of benefit seems to decrease with higher KCI scores.
Keywords: non-small-cell lung cancer, Klabunde, cancer, comorbidity index, lung cancer
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