Trends, predictors, and impact of systemic chemotherapy in small cell lung cancer patients between 1985 and 2005

Madhusmita Behera, Camille Ragin, Sungjin Kim, Rathi N. Pillai, Zhengjia Chen, Conor E. Steuer, Nabil F. Saba, Chandra P. Belani, Fadlo R. Khuri, Suresh S. Ramalingam, Taofeek K. Owonikoko

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28 Scopus citations

Abstract

BACKGROUND The last 3 decades have witnessed limited therapeutic advances in small cell lung cancer (SCLC) management. This study evaluated real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to find patients diagnosed with SCLC between 1985 and 2005. The 1985-1990 period served as the baseline for a temporal analysis conducted at 5-year intervals (1985-1990, 1991-1995, 1996-2000, and 2001-2005). Cox proportional models were used to estimate the effect of chemotherapy on survival. Results were validated with a propensity-matched analysis. RESULTS There were 47,351 eligible patients: 52% were male; the median age was 71 years; and 87% were white, 7% were black, and 1.4% were Asian. The proportion of patients treated with chemotherapy was low but increased over time (38%, 55%, 50%, and 53%; P <.001). Race, diagnosis period, age, stage, and location of residence significantly predicted chemotherapy use. Females (51%), Asians (53%), and rural residents (60%) were more likely to receive chemotherapy. The median overall survival with and without chemotherapy was 9.6 and 3.6 months, respectively. Linear trend analyses showed a modest reduction in the impact of chemotherapy on survival for patients treated with chemotherapy versus untreated patients (hazard ratios [HRs], 0.59, 0.61, 0.64, and 0.62; P <.001) but an overall trend of improved survival for treated (HRs, 1.0, 1.03, 1.00, and 0.96; P =.005) and untreated patients (HRs, 1.0, 0.99, 0.94, and 0.92; P <.001). There was no survival difference between patients treated with carboplatin and patients treated with cisplatin (HR, 0.99; confidence interval [CI], 0.81-1.19; P =.875). Additional therapy beyond platinum-based chemotherapy was associated with a survival benefit (HR, 0.78; CI, 0.75-0.81; P <.001). CONCLUSIONS Chemotherapy use was associated with a survival benefit in Medicare patients with SCLC treated in a real-world setting. Cancer 2016;122:50-60. This study evaluates real-world trends in the use of systemic therapies and the impact on patient outcomes in the United States. Chemotherapy use is associated with a survival benefit in US Medicare-eligible patients with small cell lung cancer treated in a real-world setting.

Original languageEnglish (US)
Pages (from-to)50-60
Number of pages11
JournalCancer
Volume122
Issue number1
DOIs
StatePublished - Jan 1 2016

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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