Factors influencing treatment selection and survival in advanced lung cancer

  • S. Tabchi Centre Hospitalier de l’Université de Montréal
  • E. Kassouf Centre Hospitalier de l’Université de Montréal
  • M. Florescu Centre Hospitalier de l’Université de Montréal
  • M. Tehfe Centre Hospitalier de l’Université de Montréal
  • N. Blais Centre Hospitalier de l’Université de Montréal
Keywords: Advanced lung cancer, non-small-cell lung cancer, small-cell lung cancer, treatment selection, treatment decisions

Abstract

Purpose

Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions.

Methods

We retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined.

Results

During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; p < 0.001).

Conclusions

Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer.

 


Author Biographies

S. Tabchi, Centre Hospitalier de l’Université de Montréal

Hematology–Oncology Department

E. Kassouf, Centre Hospitalier de l’Université de Montréal
Hematology–Oncology Department
M. Florescu, Centre Hospitalier de l’Université de Montréal
Hematology–Oncology Department
M. Tehfe, Centre Hospitalier de l’Université de Montréal
Hematology–Oncology Department
N. Blais, Centre Hospitalier de l’Université de Montréal
Hematology–Oncology Department
Published
2017-04-27
How to Cite
Tabchi, S., Kassouf, E., Florescu, M., Tehfe, M., & Blais, N. (2017). Factors influencing treatment selection and survival in advanced lung cancer. Current Oncology, 24(2), e115-e122. https://doi.org/10.3747/co.24.3355
Section
Medical Oncology