Is there a survival benefit in the receipt of guideline recommended therapy in non metastatic non small cell lung cancer? — ASN Events
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Is there a survival benefit in the receipt of guideline recommended therapy in non metastatic non small cell lung cancer? (#712)

Kirsten J Duggan 1 , Shalini K Vinod 2 3 , Joseph Descallar 4
  1. SLHD & SWSLHD Clinical Cancer Registry, Liverpool Hospital, Liverpool, NSW, Australia
  2. Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Liverpool Hospital, Liverpool, NSW, Australia
  3. South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  4. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

Background: Lung cancer presents a considerable disease burden for South Western Sydney (SWS) residents, representing over 10% of all diagnoses, and over 21% of all cancer mortality. Guideline recommended therapy (GRT) can facilitate sound clinical decision making in the management of Lung cancer patients. The potential survival benefit that can be gained from GRT is most likely seen in patients without distant metastases at diagnosis. The study aim is to evaluate whether survival benefit was associated with the receipt of GRT in this sub group of patients.

Method: Patients residing in SWS, with a new diagnosis of Lung cancer in 2006-2008, were identified from the SWS&SLHD Clinical Cancer Registry (CCR). Tumour details, stage, treatment, performance status (ECOG) and outcome were investigated. Treatment received was compared against Australian clinical practice guidelines. Patients in whom GRT could be assessed (documented stage and ECOG) were included for analysis. Multivariate analysis by Cox proportional hazards model was used to determine survival differences between patients receiving GRT and those who did not. Univariate analysis was conducted to investigate survival differences between GRT therapeutic modalities.

Results: 214 Stage I-III non-small cell lung cancers (NSCLC) identified. 62% were male and the median age was 70. 25% had Stage I&II, 33% Stage IIIA, and 42% had Stage IIIB NSCLC. Pathology distribution was 28% adenocarcinoma, 31% large cell, and 31% squamous cell. 57% of Stage I&II, 58% of Stage IIIA, and 25% of Stage IIIB NSCLC received GRT. GRT was not associated with improved survival in any group. For those who received GRT, surgery in Stage I&II NSCLC and radiotherapy in Stage IIIA & IIIB NSCLC was associated with a survival benefit when compared with other GRT for each group.

Conclusion: The receipt of GRT in non-metastatic NSCLC was not associated with a survival benefit. This may be due to the wide definition of GRT used in this study. Specific types of GRT were associated with improved survival per stage of NSCLC.

The authors declare no conflicts of interest