Small-cell lung cancer patients face barriers to receiving standard-of-care treatment

January 4, 2018, University of Texas M. D. Anderson Cancer Center

Despite decades of clinical research establishing chemotherapy with thoracic radiation as the standard-of-care for the initial management of non-metastatic small-cell lung cancer (SCLC), a large percentage of U.S. patients do not receive these treatments and in turn have lower overall survival, according to research from The University of Texas MD Anderson Cancer Center.

The findings, reported today in JAMA Oncology, also describe obstacles encountered by patients when receiving cancer treatments, such as their insurance status and .

"For patients who received both chemotherapy and radiation, median survival was 18 months. Among the group of patients who received neither chemotherapy nor radiation, prognosis was dismal with a median survival of only 3-4 months," explained senior author Stephen G. Chun, M.D., assistant professor of Radiation Oncology. "In order to improve access to care and address related disparities, it is critical to understand the barriers patients face when getting treated for lung cancer," said Chun.

While patients with Federal government insurance (Medicare/Medicaid) were just as likely to receive chemotherapy as those with private insurance, they were significantly less likely to receive . Being uninsured was associated with a lower likelihood of both chemotherapy and radiation administration, explained Chun.

For the retrospective, population-based study, the MD Anderson team used the National Cancer Database (NCDB), a nationwide outcomes registry of the American College of Surgeons, the American Cancer Society and the Commission on Cancer. They identified 70,247 patients diagnosed with non-metastatic, or limited-stage, SCLC and evaluated survival and socioeconomic factors to determine obstacles to cancer utilization in the United States.

The patients were 55.3 percent female and 44.7 percent male. Initial treatment was 55.5 percent chemotherapy and radiation, 20.5 percent chemotherapy alone, 3.5 percent radiation alone, 20 percent neither chemotherapy nor radiation and 0.5 percent not reported.

Patients who received chemotherapy and radiation had a median survival of 18.2 months. Patients who received either chemotherapy or radiation alone had a median survival of 10.5 and 8.3 months, respectively. Patients who received neither chemotherapy nor radiation therapy had a significantly worse median survival, 3.7 months, compared with all other treatment groups.

Multiple socioeconomic factors were highly associated with overall survival. Treatment at a non-academic center, lack of health insurance and Medicare/Medicaid coverage were also associated with significantly shorter survival.

"There are targeted access programs that provide competitive reimbursement for the administration of chemotherapy, and our findings suggest that these programs have improved chemotherapy access," said Chun. "However, these programs give no financial assistance for radiation therapy, which could in part, explain why patients with Medicare and Medicaid were less likely to receive radiation."

One limitation of the study was a small amount of cases with insufficient date or follow-up. The NCDB limits data collected to the first course of treatment. It is impossible to know if patients eventually received standard-of-care treatment, according to Chun. Additionally, while and are reported, the NCDB does not provide information on whether they were delivered concurrently or sequentially.

"Receiving appropriate, evidence-based therapies for limited-stage SCLC is critical, and our findings underscore the need for to personally advocate for the standard-of-care treatment for their ," said Chun.

Additional research is planned to further define population patterns, specific treatment insufficiencies and the contributing factors to wide-ranging care delivery.

Explore further: Medulloblastoma patients should receive both chemotherapy and radiation post-surgery

Related Stories

Medulloblastoma patients should receive both chemotherapy and radiation post-surgery

September 26, 2016
In a recent study, a Yale Cancer Center team revealed that the addition of chemotherapy to postoperative treatment for adults with medulloblastoma improves survival. The benefit of chemotherapy, in addition to craniospinal ...

Lung cancer patients who have surgery live longer

June 9, 2016
Patients with late-stage, non-small cell lung cancer (NSCLC) who have surgery have better survival rates than those who don't, but fewer of these patients are undergoing surgery, UC Davis researchers have found.

Chemotherapy helps elderly patients with small cell lung cancer

September 4, 2013
Although numerous randomized clinical trials have demonstrated a benefit of chemotherapy for patients with small-cell lung cancer (SCLC), these trials have predominantly compared different chemotherapy regimens rather than ...

Study confirms chemoradiation is best treatment for locally advanced cervical cancer

September 11, 2017
A 14-year randomised trial in more than 600 patients has concluded that chemoradiation should remain the standard treatment for patients with locally advanced cervical cancer. The findings are reported today at the ESMO 2017 ...

Surgery and radiation improve survival for metastatic gastric cancer patients, study shows

February 27, 2013
Researchers at Moffitt Cancer Center studied patients with metastatic gastric cancer and found that those who have both surgery and radiation have better survival than those who receive one or no form of treatment.

Surgery tied to longer survival for lung cancer patients

June 22, 2016
(HealthDay)—Many patients with advanced stage non-small-cell lung cancer (NSCLC) might live longer if treated surgically, but few patients are actually undergoing surgery, according to a study published online June 9 in ...

Recommended for you

Single-cell study in a childhood brain tumor affirms the importance of context

April 20, 2018
In defining the cellular context of diffuse midline gliomas, researchers find the cells fueling their growth and suggest a potential approach to treating them: forcing their cells to be more mature.

Aggressive breast cancer already has resistant tumour cells prior to chemotherapy

April 20, 2018
Difficult to treat and aggressive "triple-negative" breast cancer is chemoresistant even before chemotherapy begins, a new study by researchers from Karolinska Institutet and the University of Texas MD Anderson Cancer Center ...

Mechanism that drives development of liver cancer brought on by non-alcoholic fatty liver disease discovered

April 19, 2018
A team of researchers from several institutions in China has found a mechanism that appears to drive the development of a type of liver cancer not caused by alcohol consumption. In their paper published in the journal Science ...

Discovery adds to evidence that some children are predisposed to develop leukemia

April 19, 2018
St. Jude Children's Research Hospital researchers have made a discovery that expands the list of genes to include when screening individuals for possible increased susceptibility to childhood leukemia. The finding is reported ...

Scientists identify 170 potential lung cancer drug targets using unique cellular library

April 19, 2018
After testing more than 200,000 chemical compounds, UT Southwestern's Simmons Cancer Center researchers have identified 170 chemicals that are potential candidates for development into drug therapies for lung cancer.

Chip-based blood test for multiple myeloma could make bone biopsies a relic of the past

April 19, 2018
The diagnosis and treatment of multiple myeloma, a cancer affecting plasma cells, traditionally forces patients to suffer through a painful bone biopsy. During that procedure, doctors insert a bone-biopsy needle through an ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.