Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
Yu-Wei Chen , Angela Y. Chang , Chen-Hao Chen , Yu-Han Chiu , Yen-Chen Feng , Sheng-Hsuan Lin , Yi-Han Sheu , Yen-Fen Lin
Background: Surgery or radiation therapy (RT) remains the definitive treatment for early-stage (Stage I/II) non-small cell lung cancer (NSCLC). Early-stage NSCLC should be treated appropriately since survival decreases progressively with advanced stages. Our study aims to identify the factors associated with receiving no definitive therapy among US patients. Methods: Patients ≥ 18 years and diagnosed with stage I/II NSCLC from 2004-2011 in Surveillance, Epidemiology and End Results Program (SEER) were identified. Definitive therapy was defined as receiving surgery and/or RT. Socio-economic characteristics (income, educational status and residence type) were collected at county-level. Predictors for no definitive therapy were estimated with a multivariable logistic regression model. Results: A total of 32,401 patients were identified. 4,997 patients (15%) had no definitive therapy and among them only 456 (9%) did not receive surgery due to contraindications/patient refusal. Independent predictors for no definitive therapy include individual characteristics, such as older age, male, African Americans, not-married status, histology types other than adenocarcinoma, as well as county-level characteristics include living in a county with lower median household income, higher percentage of population with education level < high school, and a non-metropolitan setting. Conclusions: A significant proportion of patients diagnosed with early-stage NSCLC in the US did not receive definitive therapy. Socio-economic characteristics should be explored further to explain this phenomenon.
Adjusted OR 95% CI | |
---|---|
Age (every 10 years increase) | 1.86 (1.80-1.92) |
Median house Income (every 10,000 USD increase) | 0.86 (0.81-0.91) |
%Education < high school level (every 20% increase) | 1.39 (1.23-1.56) |
Sex | |
Male vs Female | 1.32 (1.02-2.10) |
Race | |
Black vs White | 1.67 (1.51-1.85) |
Other vs White | 1.14 (0.99-1.31) |
Marital status | |
Married/Domestic partners | Ref |
Single/Divorced/Separated/Widowed | 1.96 (1.83-2.10) |
Residence | |
Non-Metropolitan vs Metropolitan | 1.12 (1.02-1.24) |
Histology type | |
Squamous cell carcinoma vs Adenocarcinoma | 1.13 (1.04-1.23) |
Others vs Adenocarcinoma | 2.37 (2.20-2.56) |
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