Small Cell Lung Cancer: Barriers to Chemotherapy, Radiation

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A considerable proportion of patients with SCLC did not receive chemotherapy or radiation therapy between 2004 and 2013.
A considerable proportion of patients with SCLC did not receive chemotherapy or radiation therapy between 2004 and 2013.

HealthDay News — A considerable proportion of patients with small cell lung cancer (SCLC) do not receive chemotherapy or radiation therapy, according to a study published online in JAMA Oncology.

Todd A. Pezzi, MD, from the University of Texas MD Anderson Cancer Center in Houston, and colleagues examined utilization rates and factors associated with chemotherapy and radiation therapy delivery for limited-stage SCLC. Data were analyzed from 70,247 cases from 2004 to 2013 in the National Cancer Database.

The researchers found that initial treatment was chemotherapy and radiation therapy, chemotherapy alone, radiation therapy alone, and neither (55.5%, 20.5%, 3.5%, and 20%, respectively), with median survival of 18.2, 10.5, 8.3, and 3.7 months, respectively. On multivariable analysis, being uninsured correlated with a reduced likelihood of chemotherapy and radiation therapy (odds ratios, 0.65 and 0.75, respectively). Medicare/Medicaid insurance did not impact chemotherapy use, while the likelihood of radiation therapy delivery was independently reduced with Medicaid and Medicare (odd ratios, 0.79 and 0.86, respectively). 

On adjusted analysis, lack of health insurance, Medicaid, and Medicare correlated with shorter survival (hazard ratios, 1.19, 1.27, and 1.12, respectively), while chemotherapy and radiation therapy correlated with survival benefit (hazard ratios, 0.55 and 0.62, respectively).

"Substantial proportions of patients documented in a major US cancer registry did not receive radiation therapy or chemotherapy as part of initial treatment for limited-stage SCLC, which, in turn, was associated with poor survival," the authors wrote.

Disclosures: One author disclosed financial ties to Elekta AB.

Reference

Pezzi TA, Schwartz DL, Mohamed ASR, et al. Barriers to combined-modality therapy for limited-stage small-cell lung cancer [published online January 4, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2017.4504

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