Faculty Collaboration Database

Radiotherapy patterns of care study in lung carcinoma. J Clin Oncol 2003 Dec 15;21(24):4553-9

Date

11/05/2003

Pubmed ID

14597743

DOI

10.1200/JCO.2003.04.018

Scopus ID

2-s2.0-1542648395 (requires institutional sign-in at Scopus site)   92 Citations

Abstract

PURPOSE: For the first time, a lung Patterns of Care Study was conducted to determine the national patterns of radiation (RT) practice in patients treated for nonmetastatic lung cancer in 1998 to 1999.

MATERIALS AND METHODS: A national survey of randomly selected RT institutions in the United States was conducted using two-stage cluster sampling, stratified by practice type. Patients with nonmetastatic lung cancer (Karnofsky performance score [KPS] > or = 60), who received RT as definitive or adjuvant therapy, were randomly selected. To determine national estimates, sample size was weighted by the relative number of institutions per strata and the number of patient records reviewed per the number of patients eligible. Accordingly, 42,335 patient records from 58 institutions were reviewed by trained research associates. The unweighted sample size (or number of patients) was 541.

RESULTS: The histologies were small-cell lung cancer (SCLC) in 14.5% of patients versus non-small-cell lung cancer (NSCLC) in 85.5% of patients. The median age was 67 years (range, 29 to 92 years); 61% of patients were male, and 38% were current smokers. Bone scans and brain imaging were not obtained in 34% and 52% of clinical stage (CS) III NSCLC patients, respectively. Regarding treatment strategies, for SCLC and CS III NSCLC, chemotherapy plus RT was used significantly more than RT alone (P <.05); in CS I NSCLC, RT alone was the primary treatment (P <.05). Overall, 58% of patients received systemic therapy. On multivariate analysis, factors correlating with increased use of chemotherapy included younger age, histology (SCLC > NSCLC), increasing CS, increasing KPS, and lack of comorbidities. Only 3% of all patients were treated on prospective clinical trials.

CONCLUSION: This study establishes the general patterns of care for lung carcinoma in RT facilities within the United States. As supported by clinical trials, patients with limited-stage SCLC and CS III NSCLC received chemotherapy plus RT more than they received RT alone. Further improvements in staging, smoking cessation, and increased accrual to clinical trials must be encouraged.

Author List

Movsas B, Moughan J, Komaki R, Choy H, Byhardt R, Langer C, Goldberg M, Graham M, Ettinger D, Johnstone D, Abrams R, Munden R, Starkschall G, Owen J

Author

David Johnstone MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
Carcinoma, Small Cell
Chi-Square Distribution
Female
Guideline Adherence
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Patient Selection
Practice Patterns, Physicians'
Quality of Health Care
Sampling Studies
United States