Clinical outcomes and resource utilization after surgical resection with curative intent among patients with non‐small cell lung cancer treated with adjuvant therapies in a community oncology setting: A real‐world retrospective observational study

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Abstract

Aims

Adjuvant chemotherapy has been shown to improve survival in patients with completely resected early‐stage non‐small cell lung cancer (NSCLC). This study evaluated real‐world relapse rates and healthcare resource utilization in patients with stage II–IIIB NSCLC receiving adjuvant therapy in a community oncology setting after complete resection.

Patients and Methods

The study included patients with stage II–IIIB NSCLC and complete resection receiving any adjuvant therapy during 06/2008–04/2017 at US Oncology Network clinics, with follow‐up through 04/2019. Primary endpoints were rate of relapse, time to relapse (TTR), disease‐free survival (DFS), overall survival (OS), and monthly emergency department (ED) visits and hospitalizations before and after relapse.

Results

The study identified 456 patients; median age was 66 years, 50% were male. In patients with relapse (45.2%), median follow‐up was 31.7 months and median TTR was 13.7 months. Median DFS in the overall population was 42.9 months. Median OS was 82.4 months in the overall population and shorter in patients with relapse than without relapse (41.6 months vs. not reached, p < 0.0001). Patients with relapse had significantly more monthly ED visits (mean [SD] 0.10 [0.24] vs. 0.03 [0.08], p < 0.0001) and hospitalizations (mean [SD] 0.20 [0.43] vs. 0.05 [0.10], p < 0.0001) following relapse than before relapse.

Conclusions

Patients with stage II–IIIB NSCLC treated with adjuvant therapy after complete resection had high relapse rates, reduced survival, and significantly increased healthcare resource use when relapse occurred. New therapeutic options to reduce relapse rates in patients with early‐stage NSCLC could reduce healthcare utilization and costs.

Abstract

This retrospective study evaluated real‐world relapse rates and healthcare resource utilization in patients with stage II–IIIB non‐small cell lung cancer receiving adjuvant therapy after complete resection in community‐based oncology practices. Patients had high relapse rates, reduced survival, and significantly increased healthcare resource use when relapse occurred.

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Most cited references 19

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Cancer statistics, 2020

Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2020)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.

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The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.

Stephen B. Edge, Carolyn C. Compton (2010)

The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.

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Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group.

Jean-Pierre Pignon, Hélène Tribodet, Giorgio Scagliotti … (2008)

Several recent trials have shown a significant overall survival (OS) benefit from postoperative cisplatin-based chemotherapy in patients with non-small-cell lung cancer (NSCLC). The aim of the Lung Adjuvant Cisplatin Evaluation was to identify treatment options associated with a higher benefit or groups of patients who particularly benefit from postoperative chemotherapy. Individual patient data were collected and pooled from the five largest trials (4,584 patients) of cisplatin-based chemotherapy in completely resected patients that were conducted after the 1995 NSCLC meta-analysis. The interactions between patient subgroups or treatment types and chemotherapy effect on OS were analyzed using hazard ratios (HRs) and log-rank tests stratified by trial. With a median follow-up time of 5.2 years, the overall HR of death was 0.89 (95% CI, 0.82 to 0.96; P = .005), corresponding to a 5-year absolute benefit of 5.4% from chemotherapy. There was no heterogeneity of chemotherapy effect among trials. The benefit varied with stage (test for trend, P = .04; HR for stage IA = 1.40; 95% CI, 0.95 to 2.06; HR for stage IB = 0.93; 95% CI, 0.78 to 1.10; HR for stage II = 0.83; 95% CI, 0.73 to 0.95; and HR for stage III = 0.83; 95% CI, 0.72 to 0.94). The effect of chemotherapy did not vary significantly (test for interaction, P = .11) with the associated drugs, including vinorelbine (HR = 0.80; 95% CI, 0.70 to 0.91), etoposide or vinca alkaloid (HR = 0.92; 95% CI, 0.80 to 1.07), or other (HR = 0.97; 95% CI, 0.84 to 1.13). Chemotherapy effect was higher in patients with better performance status. There was no interaction between chemotherapy effect and sex, age, histology, type of surgery, planned radiotherapy, or planned total dose of cisplatin. Postoperative cisplatin-based chemotherapy significantly improves survival in patients with NSCLC.

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Author and article information

Contributors

Beilei Cai: beilei.cai@novartis.com

Journal

Journal ID (nlm-ta): Thorac Cancer

Journal ID (iso-abbrev): Thorac Cancer

Journal ID (doi): 10.1111/(ISSN)1759-7714

Journal ID (publisher-id): TCA

Title: Thoracic Cancer

Publisher: John Wiley & Sons Australia, Ltd (Melbourne )

ISSN (Print): 1759-7706

ISSN (Electronic): 1759-7714

Publication date (Electronic): 24 May 2021

Publication date (Print): July 2021

Volume: 12

Issue: 14 ( doiID: 10.1111/tca.v12.14 )

Pages: 2055-2064

Affiliations

[ ¹ ] Novartis Pharmaceuticals East Hanover New Jersey USA

[ ² ] Ontada The Woodlands Texas USA

[ ³ ] Virginia Cancer Specialists/The US Oncology Network Fairfax Virginia USA

Author notes

[*] [* ] Correspondence

Beilei Cai, Novartis Pharmaceuticals, 1 Health Plaza, East Hanover, NJ 07936, USA.

Email: beilei.cai@ 123456novartis.com

Article

Publisher ID: TCA14007

DOI: 10.1111/1759-7714.14007

PMC ID: 8287010

PubMed ID: 34028984

SO-VID: 9029f751-6f6a-4f56-b967-31f11df71d45

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 30 April 2021

Date received : 10 March 2021

Date accepted : 03 May 2021

Page count

Figures: 3, Tables: 3, Pages: 10, Words: 6032

Funding

Funded by: Novartis , doi 10.13039/100004336;

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cover-date July 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:19.07.2021

Clinical outcomes and resource utilization after surgical resection with curative intent among patients with non‐small cell lung cancer treated with adjuvant therapies in a community oncology setting: A real‐world retrospective observational study

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Abstract

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Patients and Methods

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Most cited references 19

Cancer statistics, 2020

The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.

Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group.

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