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Randeep Sangha
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FP02 - Health Services Research/Health Economics (ID 120)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP02.03 - Changing Survival and Treatment Patterns in Patients Aged 80 or Older with Stage IV Non-Small Cell Lung Cancer (NSCLC) (ID 3739)
00:00 - 00:00 | Author(s): Randeep Sangha
- Abstract
Introduction
NSCLC is a disease of the elderly, with a median age at diagnosis of 70 years old. Yet elderly patients with NSCLC are under-represented in clinical trials, and studies of real-world treatment patterns have consistently identified lower rates of systemic therapy administration in this patient population. However there are clinical trial data to suggest that even the very elderly (age 80+) with advanced NSCLC can benefit from system therapy. We therefore looked at real-world patterns of treatment and survival in a cohort of patients aged 80 or older with metastatic NSCLC.
Methods
We performed a retrospective analysis of a cohort of 721 patients aged 80 or older diagnosed with de novo stage IV NSCLC in Alberta, Canada between 2011-2016 using the Glans-Look database. Data was derived from the provincial cancer registry and supplemented with additional chart review for a subset of cases. Univariate survival analysis used the Log-Rank method, and multivariate analysis Cox Regression. All other tests were Chi-Squared. Median overall survival (OS) in months is shown with 95% confidence intervals. The number of patients included for specific tests is indicated where the full cohort population is not included.
Results
Over the study period, an increasing proportion of patients were treated with systemic therapy (9.5% in 2011-2012, 21.6% in 2015-2016; P < 0.001), and the proportion of patients treated with 1st line targeted therapy also increased (N = 54; 43.8% in 2011-2012, 79.2% in 2015-2016; P < 0.029). Receiving systemic therapy was associated with improved OS (17.53 (14.01 – 21.06) vs 3.67 (3.30 – 4.04) months; P < 0.001). While there was a trend towards improved OS for the entire population over time (median 3.63 (2.99 – 4.27) months in 2011-2012 vs 5.33 (4.36 – 6.30) months in 2015-216; P = 0.19), survival improved significantly for those who received systemic therapy over the study period (median 7.10 (5.087 – 9.11) months in 2011-2012 vs 20.80 (17.09 – 24.51) months in 2015-2016; P = 0.02). There was no significant difference in OS for those who received chemotherapy vs targeted therapy (N=54; 15.97 (7.84 – 24.09) months vs 18.50 (13.05 – 23.95) months; P = 0.74), suggesting that improved access to systemic therapy rather than the intrinsic nature of the therapies themselves underlie improving survival amongst treated patients.
Conclusion
We identified increasing rates of systemic therapy use in patients aged 80 or older with de novo metastatic NSCLC, and improving OS amongst treated patients over the study period. While we cannot account for all potentially relevant changes to the management of NSCLC over that time, the improvement in increasing rates of systemic therapy use and survival in treated patients are potentially driven by availability and increasing use of targeted therapies. This suggests that elderly patients with NSCLC have benefited significantly from the use of these medications.
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.04 - Changing Survival and Treatment Patterns in Patients with Stage IV Non-Small Cell Lung Cancer (NSCLC) in Alberta, Canada (ID 3737)
00:00 - 00:00 | Author(s): Randeep Sangha
- Abstract
Introduction
We have previously reported that rapid physical decline and poor performance status means that only a minority of patient with metastatic NSCLC receive systemic treatment. Over the last decade, treatment advances in the form of maintenance chemotherapy, targeted therapies and immunotherapy for advanced disease have shown benefit in randomized phase III trials and been adopted as standard of care. Nevertheless, there are conflicting reports of trends in overall survival. We therefore looked at real-world patterns of treatment and survival in a cohort of patients with metastatic NSCLC.
Methods
We performed a retrospective analysis of a cohort of 4400 patients diagnosed with de novo stage IV NSCLC in Alberta, Canada between 2011-2016 using the Glans-Look database. Data was derived from the provincial cancer registry and supplemented with additional chart review for a subset of cases. Univariate survival analysis used the Log-Rank method, and multivariate analysis Cox Regression. All other tests were Chi-Squared. Median survival in months is shown with 95% confidence intervals. The number of patients included for specific tests is indicated in cases where there was missing data.
Results
There was a trend towards improving overall survival over the study period (4.67 (4.24 – 5.10) months in 2011, and 5.90 (5.22 – 6.58) months in 2016; univariate P = 0.092). We observed an increasing proportion of patients with no smoking history (N = 1257; 11.2% in 2011 vs 31.6% in 2016; P < 0.001), an increasing proportion of patients receiving systemic therapy (29.1% in 2011 vs 38.0% in 2016; P < 0.001), and an increasing proportion of patients treated with systemic therapy that received 1st line targeted therapy (N = 541; 20.3% in 2011 vs 39.1% in 2016; P < 0.001). These factors were also associated with improved overall survival in univariate analysis: never smoker vs ever smoker (N = 541; 17.47 (14.61 – 20.33) months vs 6.33 (5.47 – 7.19) months; P < 0.001); receipt of systemic therapy (12.00 (11.30 – 12.70) months vs 3.10 (2.94 – 3.26) months; P < 0.001) targeted therapy vs chemotherapy (N = 541 ; 19.30 (16.06 – 22.54) months vs 15.98 (14.37 – 17.56) months; P = 0.015). Younger age at diagnosis, female gender, receiving systemic therapy, and use of 1st line targeted therapy vs chemotherapy were all significantly associated with improved survival in multivariate models (smoking status excluded from analysis due to number of cases with missing data).
Conclusion
We observed a trend towards improving survival from 2011 to 2016 in patient with stage IV NSCLC in Alberta, Canada. While we cannot account for all potentially relevant changes to the management of NSCLC over that time, we observed increasing rates of systemic therapy administration and use of 1st line targeted therapy, which may be in part responsible for improving survival.
