Elsevier

Lung Cancer

Volume 57, Issue 3, September 2007, Pages 253-260
Lung Cancer

National survey of non-small cell lung cancer in the United States: Epidemiology, pathology and patterns of care

https://doi.org/10.1016/j.lungcan.2007.03.012Get rights and content

Summary

Purpose

To determine the epidemiology, pathology and patterns of care for patients with non-small cell lung cancer (NSCLC) in the United States.

Methods

In 2001 the National Cancer Data Base, under direction of the American College of Surgeons, conducted a patient care evaluation study in 719 hospitals. We collected information on patient demographics and histories, diagnostic and staging methods, pathology, and initial treatment.

Results

Information on 40,909 patients was obtained; 93% were smokers. Slightly more than half were older than 70 years; 58.5% were male and 35% had adenocarcinoma. Comorbid conditions were present in 71.8% and 22% had a prior malignancy. A chest CT scan was performed in 92% of patients and PET scans in 19.3%. Mediastinoscopy was performed in 20.3%. 67.2% of patients had Stage III or IV disease. More of the Hispanic, Asian or Black patients than White had Stage IV disease (p < 0.01). Treatment was multimodality in a little over 30% of patients. Surgery alone was primarily utilized for patients in Stage I or II. Choice of treatment correlated more with stage and age than comorbidities.

Conclusion

Our results substantiated the pattern of increasing proportions of women with NSCLC and the increasing frequency of adenocarcinoma. Most patients presented with Stage III or IV disease. Ethnic minorities were more likely to present in late stage disease than Whites. Treatment strategies depended more on stage and age than comorbid burden. Older patients were less likely to receive surgery and more likely to be treated with radiation only or have no treatment.

Introduction

In the United States in 2006, carcinoma of the lung and bronchus constituted an estimated 13% of all new cancer cases in men and 12% in women. Excluding skin cancers, lung cancer is the second most common cancer in both sexes. In 2006, bronchogenic cancer accounted for about 31% of all cancer deaths in men and 26% in women, making it the most common cancer killer in both sexes. In 2006, approximately 174,470 new cases of lung cancer were diagnosed and 162,460 deaths due to lung cancer occurred [1]. Because of this clinical impact, the Commission on Cancer (CoC) of the American College of Surgeons (ACoS) conducted a national patient care evaluation (PCE) study of non-small cell lung cancer (NSCLC) patients diagnosed in 2001. The aims included the determination of current demographics, identification of diagnostic and staging modalities and analysis of patterns of alternative therapeutic strategies. This study is part of the commitment of the Commission on Cancer of the American College of Surgeons to determine the patterns of care of various types of cancer in the United States [2], [3].

Section snippets

National Cancer Data Base

The National Cancer Data Base (NCDB), joint project of the CoC, the ACoS and the American Cancer Society (ACS), is a clinical surveillance resource for all forms of cancer diagnosed in the United States. All of the approximately 1423 CoC approved hospitals respond to annual calls for data for inclusion in the NCDB. In 2001, the data base captured 73% of all newly diagnosed cancer cases.

A call for voluntary participation in a one year PCE to look specifically and only at the year 2001 was issued

Patient characteristics

A total of 40,909 patients with microscopically confirmed primary NSCLC in calendar year 2001 were included. Slightly more than half were age 70 or older (Table 1). Overall, there were more males (58.5%) than females (41.5%); however, proportionately by age group, there was no significant difference (p = 0.09). Racial distribution was as follows: 84.9% were White, 10.2% Black, 2.6% Hispanic, 2.1% Asian; and 0.2% were Native American. Insurance status varied by race/ethnicity. Hispanics (9.4%)

Discussion

The role of carcinogens in cigarette smoke in the pathogenesis of NSCLC has been identified [7]. Tobacco smoking is the most important risk factor for lung cancer [7]. Our report emphasizes this as 92.9% of our patients were smokers, slightly higher than reported elsewhere (85–90%) [8].

The majority of patients were 70 years or older and presented with some coexisting medical condition. Similar to findings from an earlier study [9], the most common two coexistent diseases were COPD and high

Study limitations

Our survey is unable to identify why any particular approach to patient care is used (or not used). However, the data can suggest potential areas of modification or improvement such as undertreatment of Stage I patients and surgical treatment of Stage IV patients.

Comorbid burden was measured by summation of pre-existing disease in lieu of a cancer specific risk adjustment measure. No reliable and valid risk adjustment measure has been defined specifically for cancers. Iezzoni and colleagues

Conclusions

The majority of patients were 70 or older. We confirmed the pattern of increasing women with NSCLC and the increasing frequency of adenocarcinoma. Staging strategies relied predominantly on chest CT scanning. Most patients presented with Stage III or IV disease. Ethnic minorities were more likely to present in late stage disease than Whites. Treatment strategies depended more on stage and age than comorbid burden. Given the prevalence, morbidity and mortality of NSCLC, and the aging of the

Conflict of interest statement

No authors have a conflict of interest.

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