Chest
Clinical InvestigationsCANCERWho Gets Chemotherapy for Metastatic Lung Cancer?
Section snippets
Data Sources
We studied patients from the 11 tumor registries participating in the SEER (surveillance, epidemiology, and end results) program of the National Cancer Institute: San Francisco/Oakland, CT, Detroit, HI, IA, NM, Seattle/Puget Sound, UT, Atlanta, San Jose/Monterey, and Los Angeles. These registries collect uniform information on all cancers diagnosed within their geographic regions, capturing about 97% of all incident cases in those areas.12 The geographic areas covered by SEER areas contain
Patient Characteristics
Table 1 shows the characteristics of the 6,308 patients meeting our eligibility criteria. The average patient age was 74.2 years, and almost two-thirds were men. The majority of patients (84%) were non-Hispanic white, with< 10% in each of the other racial groups. Eighty-five percent of patients lived in an urban setting. The Detroit registry contributed the most patients, followed by CT, IA, Seattle/Puget Sound, Los Angeles, and San Francisco/Oakland. The histologic diagnoses were mostly
Discussion
This study, the first to use large population-based data sets to assess chemotherapy utilization in advanced lung cancer, produced several interesting findings. The 21.5% of Medicare patients with stage IV NSCLC receiving chemotherapy for their lung cancer indicates that chemotherapy use is increasing relative to the rates reported in older studies. However, despite the fact that all patients in our cohort had the same health insurance coverage, the use of chemotherapy was far from consistent
Conclusion
The use of palliative chemotherapy appears to be increasing. Chemotherapy or supportive care can be appropriate choices in different clinical situations, so the appropriate level of chemotherapy use cannot be known. However, unless they are markers for patient treatment preferences, nonmedical factors such as race, geographic location, socioeconomic status, or treatment setting should not significantly affect management recommendations. Research to further clarify the costs, benefits, and
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Dr. Earle is a Cancer Care Ontario Research Fellow.
Supported in part by National Institutes of Health grant CA 72663.