Patients With Small-Cell Lung Cancer Face Barriers to Combined-Modality Therapy

While chemotherapy with thoracic radiation has been established as the standard of care for the initial treatment of non-metastatic small-cell lung cancer, a large proportion of patients do not receive these treatments and in turn have lower overall survival, according to a study published in JAMA Oncology.

A large percentage of patients with non-metastatic small-cell lung cancer (SCLC) face substantial barriers to standard-of-care therapy and in turn have lower overall survival, according to research from The University of Texas MD Anderson Cancer Center, which was published in JAMA Oncology.

“Approximately 15% to 30% of lung cancers are SCLC, and one-third of cases are diagnosed in the limited stage (LS),” wrote the authors. They continued, “For LS-SCLC, initial management with concurrent chemotherapy and thoracic radiation therapy is the standard of care in the United States.”

The authors analyzed initial management of all LS-SCLC cases from 2004 to 2013 in the National Cancer Database (NCDB). A total of 70,247 patients were included, and their baseline characteristics were determined; 55.3% of patients were women. The initial treatment was 55.5% chemotherapy and radiation, 20.5% chemotherapy alone, 3.5% radiation therapy alone, 20% neither chemotherapy nor radiation therapy, and 0.5% not reported.

There was a median follow-up of 62.3 (95% Cl, 62.3-64.1) months, and survival was compared between the groups. Results showed that patients who received chemotherapy and radiation had significantly better median survival (18.2 months; 95% Cl, 17.9-18.4 months) than any other group (P <.001). Patients who received chemotherapy or radiation therapy alone had a median survival of 10.5 (95% Cl, 10.3-10.7) and 8.3 (95% Cl, 7.7-8.8) months, respectively. The group of patients who received neither chemotherapy nor radiation therapy had worse median survival (3.7 months; 95% Cl, 3.5-3.8 months) when compared with any other group.

The authors also found that a patient’s lack of insurance (odds ratio [OR], 0.75; 95% Cl, 0.67-0.85; P <.001), coverage through Medicaid (OR, 0.79; 95% CI, 0.72-0.87; P &thinsp;<&thinsp;.001), and coverage through Medicare (OR, 0.86; 95% CI, 0.82-0.91; P &thinsp;<&thinsp;.001) were associated with a decreased likelihood of receiving radiation therapy in comparison with private or managed care insurance. Being uninsured (OR, 0.65; 95% CI, 0.56-0.75; P &thinsp;<&thinsp;.001) was also associated with a lower likelihood of chemotherapy delivery; however, neither Medicaid (OR, 1.01; 95% CI, 0.92-1.10; P &thinsp;=&thinsp;.86) nor Medicare insurance (OR, 0.97; 95% CI, 0.91-1.03; P &thinsp;=&thinsp;.36) was associated with chemotherapy delivery.

Several socioeconomic factors, such as treatment at a non-academic center, lack of health insurance and Medicare or Medicaid coverage were associated with significantly shorter survival.

“Receiving appropriate, evidence-based therapies for limited-stage SCLC is critical, and our findings underscore the need for patients to personally advocate for the standard-of-care treatment for their cancer,” said senior author Stephen G. Chun, MD, assistant professor, Radiation Oncology, University of Texas MD Anderson Cancer Center, in a statement.