scholarly journals Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  
2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.


2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.


2019 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have NSCLC, had poorer lung function and were more likely to have an ECOG status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). SABR has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.


2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.


2018 ◽  
Author(s):  
Praveen Sridhar ◽  
Hiran C Fernando

Lung cancer is the leading cause of cancer death in both men and women. This is related to the high prevalence and high mortality particularly when presenting at an advanced stage. Surgical resection remains the standard curative therapy for early-stage lung cancer. However, many patients are not able to tolerate resection secondary to poor respiratory reserve and other comorbid diseases. Stereotactic body radiation therapy (SBRT) and percutaneous thermal ablation are minimally invasive techniques that have been used to treat other solid tumors with curative intent. Over the past decade, there has been an expansion in the roles of both SBRT and thermal ablation in the treatment of early-stage lung tumors. The encouraging results from several studies have led to the incorporation of these therapies, particularly SBRT, as the standard of care for curative-intent treatment of patients with medically inoperable early-stage lung cancer. This chapter presents an overview of the approach to patient selection as well as provides a review of the current evidence for SBRT, percutaneous thermal ablation, and bronchoscopic ablation for early-stage nonsmall cell lung cancers. This review contains 3 figures, 4 tables, and 28 references Key Words: stereotactic body radiation therapy, percutaneous thermal ablation, cryoablation, microwave ablation, endoscopic ablation, bronchoscopic ablation, radiofrequency ablation, early stage NSCLC therapy


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