Treatment trends in early-stage lung cancer in the United States, 2004 to 2013

A time-trend analysis of the National Cancer Data Base

Kathryn E. Engelhardt, Joseph M Feinglass, Malcolm M. DeCamp, Karl Y Bilimoria, David Duston Odell

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The study objective was to evaluate trends in the use of surgical therapy for patients with early-stage (IA-IIA) non–small cell lung cancer when stereotactic ablative radiotherapy was introduced in the United States. Methods: Patients with clinical stage IA to IIA non–small cell lung cancer diagnosed from January 1, 2004, to December 31, 2013, were identified in the National Cancer Data Base. The Cochran–Armitage trend test was used to evaluate the change in the proportion of patients undergoing surgery over time. Logistic regression was used to identify the factors associated with receipt of surgery compared with radiation. Results: Of 200,404 eligible patients from 1235 hospitals, 79.8% (n = 159,943) underwent surgery. For all stages combined, the rate of surgery decreased from 83.9% in 2004 to 75.1% in 2013 (P <.0001), with the largest decrease seen in patients with stage IIA: stage IA 86.5% to 77.1% (P <.0001); stage IB 79.6% to 71.5% (P <.0001); and stage IIA 94.7% to 70.3% (P <.001). Patients were more likely to undergo surgery if they were younger and white, had higher income, or had private or Medicare insurance. Conclusions: From 2004 to 2013, there was an overall decrease in the use of surgical therapy for lung cancer in early-stage disease. Because resection remains the standard of care for most patients with early-stage disease, these data suggest a potentially significant quality gap in the treatment of patients with non–small cell lung cancer.

Original languageEnglish (US)
Pages (from-to)1233-1246.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Lung Neoplasms
Databases
Neoplasms
Non-Small Cell Lung Carcinoma
Therapeutics
Standard of Care
Medicare
Insurance
Radiotherapy
Logistic Models
Radiation

Keywords

  • health care utilization
  • lung cancer
  • stereotactic body radiotherapy
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{226128f09407450ea3e1965a519ad3b6,
title = "Treatment trends in early-stage lung cancer in the United States, 2004 to 2013: A time-trend analysis of the National Cancer Data Base",
abstract = "Objective: The study objective was to evaluate trends in the use of surgical therapy for patients with early-stage (IA-IIA) non–small cell lung cancer when stereotactic ablative radiotherapy was introduced in the United States. Methods: Patients with clinical stage IA to IIA non–small cell lung cancer diagnosed from January 1, 2004, to December 31, 2013, were identified in the National Cancer Data Base. The Cochran–Armitage trend test was used to evaluate the change in the proportion of patients undergoing surgery over time. Logistic regression was used to identify the factors associated with receipt of surgery compared with radiation. Results: Of 200,404 eligible patients from 1235 hospitals, 79.8{\%} (n = 159,943) underwent surgery. For all stages combined, the rate of surgery decreased from 83.9{\%} in 2004 to 75.1{\%} in 2013 (P <.0001), with the largest decrease seen in patients with stage IIA: stage IA 86.5{\%} to 77.1{\%} (P <.0001); stage IB 79.6{\%} to 71.5{\%} (P <.0001); and stage IIA 94.7{\%} to 70.3{\%} (P <.001). Patients were more likely to undergo surgery if they were younger and white, had higher income, or had private or Medicare insurance. Conclusions: From 2004 to 2013, there was an overall decrease in the use of surgical therapy for lung cancer in early-stage disease. Because resection remains the standard of care for most patients with early-stage disease, these data suggest a potentially significant quality gap in the treatment of patients with non–small cell lung cancer.",
keywords = "health care utilization, lung cancer, stereotactic body radiotherapy, surgery",
author = "Engelhardt, {Kathryn E.} and Feinglass, {Joseph M} and DeCamp, {Malcolm M.} and Bilimoria, {Karl Y} and Odell, {David Duston}",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.jtcvs.2018.03.174",
language = "English (US)",
volume = "156",
pages = "1233--1246.e1",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Treatment trends in early-stage lung cancer in the United States, 2004 to 2013

T2 - A time-trend analysis of the National Cancer Data Base

AU - Engelhardt, Kathryn E.

AU - Feinglass, Joseph M

AU - DeCamp, Malcolm M.

AU - Bilimoria, Karl Y

AU - Odell, David Duston

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objective: The study objective was to evaluate trends in the use of surgical therapy for patients with early-stage (IA-IIA) non–small cell lung cancer when stereotactic ablative radiotherapy was introduced in the United States. Methods: Patients with clinical stage IA to IIA non–small cell lung cancer diagnosed from January 1, 2004, to December 31, 2013, were identified in the National Cancer Data Base. The Cochran–Armitage trend test was used to evaluate the change in the proportion of patients undergoing surgery over time. Logistic regression was used to identify the factors associated with receipt of surgery compared with radiation. Results: Of 200,404 eligible patients from 1235 hospitals, 79.8% (n = 159,943) underwent surgery. For all stages combined, the rate of surgery decreased from 83.9% in 2004 to 75.1% in 2013 (P <.0001), with the largest decrease seen in patients with stage IIA: stage IA 86.5% to 77.1% (P <.0001); stage IB 79.6% to 71.5% (P <.0001); and stage IIA 94.7% to 70.3% (P <.001). Patients were more likely to undergo surgery if they were younger and white, had higher income, or had private or Medicare insurance. Conclusions: From 2004 to 2013, there was an overall decrease in the use of surgical therapy for lung cancer in early-stage disease. Because resection remains the standard of care for most patients with early-stage disease, these data suggest a potentially significant quality gap in the treatment of patients with non–small cell lung cancer.

AB - Objective: The study objective was to evaluate trends in the use of surgical therapy for patients with early-stage (IA-IIA) non–small cell lung cancer when stereotactic ablative radiotherapy was introduced in the United States. Methods: Patients with clinical stage IA to IIA non–small cell lung cancer diagnosed from January 1, 2004, to December 31, 2013, were identified in the National Cancer Data Base. The Cochran–Armitage trend test was used to evaluate the change in the proportion of patients undergoing surgery over time. Logistic regression was used to identify the factors associated with receipt of surgery compared with radiation. Results: Of 200,404 eligible patients from 1235 hospitals, 79.8% (n = 159,943) underwent surgery. For all stages combined, the rate of surgery decreased from 83.9% in 2004 to 75.1% in 2013 (P <.0001), with the largest decrease seen in patients with stage IIA: stage IA 86.5% to 77.1% (P <.0001); stage IB 79.6% to 71.5% (P <.0001); and stage IIA 94.7% to 70.3% (P <.001). Patients were more likely to undergo surgery if they were younger and white, had higher income, or had private or Medicare insurance. Conclusions: From 2004 to 2013, there was an overall decrease in the use of surgical therapy for lung cancer in early-stage disease. Because resection remains the standard of care for most patients with early-stage disease, these data suggest a potentially significant quality gap in the treatment of patients with non–small cell lung cancer.

KW - health care utilization

KW - lung cancer

KW - stereotactic body radiotherapy

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85048880933&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048880933&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2018.03.174

DO - 10.1016/j.jtcvs.2018.03.174

M3 - Article

VL - 156

SP - 1233-1246.e1

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -