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