Patients with Stage II or IIIA NSCLC aged 18–59 were twice as likely as patients aged 70–79 to receive guideline-concordant post-operative chemotherapy.
The percentage of patients diagnosed with Stage II or IIIA non-small cell lung cancer (NSCLC) in 2010, 2011 and 2012 who received post-operative chemotherapy. Results are presented by province, age group and sex.
The 2011 Cancer System Performance Report.
Why measure this?
The delivery of chemotherapy following resection has been shown to improve outcomes (i.e., disease-free and overall survival) and prevent recurrences in patients with Stage II or IIIA NSCLC, compared with surgery alone.1-4 Clinical practice guidelines therefore recommend post-operative chemotherapy for patients with Stage II or IIIA NSCLC.5 Measuring national practice patterns relative to this evidence-based guideline can help to identify variations, which could be addressed through quality improvement initiatives.
What are the key findings?
- In the 2012 diagnosis year, the percentage of patients with Stage II or IIIA NSCLC who received post-operative chemotherapy ranged from 41.4% in Alberta to 56.1% in Ontario, of the five reporting provinces (Figure 4.27).
- Use of post-operative chemotherapy decreased with age: 63.8% of NSCLC patients aged 18–59 received postoperative chemotherapy, compared with 29.9% of those aged 70–79 (Figure 4.28).
- There were no notable sex-related differences (data not shown).
Why do these findings matter?
The data suggest that the use of post-operative chemotherapy for Stage II or IIIA NSCLC is relatively consistent among the reporting provinces, but is not consistent across age groups. Patients aged 18–59 with Stage II or IIIA NSCLC are much more likely to receive post-operative chemotherapy than are patients aged 70–79. While older patients are more likely to have conditions that reduce their ability to tolerate chemotherapy, evidence does suggest that use of post-operative chemotherapy can improve survival for patients up to age 80.6-8 Given that, it is important to understand why treatment practices may vary based on patient age. Factors that may influence use of post-operative chemotherapy in patients with Stage II or IIIA NSCLC include medical conditions that preclude its use, refusal of treatment after being referred to a medical oncologist and lack of referral to a medical oncologist.
- Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008 Jul 20;26(21):3552-9.
- Douillard JY, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzales-Larriba JL, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006 Sep;7(9):719-27.
- Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005 Jun 23;352(25):2589-97.
- Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004 Jan 22;350(4):351-60.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer Version 4.2016. 2016.
- Cuffe S, Booth CM, Peng Y, Darling GE, Li G, Kong W, et al. Adjuvant chemotherapy for non-small-cell lung cancer in the elderly: a population-based study in Ontario, Canada. J Clin Oncol. 2012 May 20;30(15):1813-21.
- Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, et al. Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol. 2014 Jul;25(7):1270-83.
- Wisnivesky JP, Smith CB, Packer S, Strauss GM, Lurslurchachai L, Federman A, et al. Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer: observational cohort study. BMJ. 2011;343:d4013.