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Non-small cell lung cancer associated with poorer prognosis in older patients with IPF
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Non-small cell lung cancer is associated with poorer prognosis and has a unique presentation in elderly patients with idiopathic pulmonary fibrosis, a recently published study showed.
“One of the most interesting observations was that the rate of treatment for advanced cancer was lower in patients with lung fibrosis and lung cancer compared with those with lung cancer without lung fibrosis,” Charles A. Powell, MD, MBA, Janice and Coleman Rabin Professor of Medicine and system chief of the division of pulmonary, critical care and sleep medicine at the Icahn School of Medicine at Mount Sinai, told Healio Pulmonology. “However, we do know that even though patients with advanced stage lung cancer have relatively low survival rates, treatment does improve length and quality of life.”
Powell and colleagues studied 54,453 Medicare beneficiaries diagnosed with non-small cell lung cancer (NSCLC) between 2007 and 2011 via the Surveillance, Epidemiology, and End Results (SEER) database. Patients aged 65 years and older with stage I to stage IV NSCLC and with at least 1 year of Medicare data prior to their diagnosis were included. Patients in HMO patients and those without outpatient, part B Medicare coverage were excluded from analysis.
The study’s long-term outcomes were lung cancer-specific and overall survival, with survival time calculated from time of diagnosis to the event of interest or its corresponding final follow-up. Participants’ age, sex, race, comorbidities and socioeconomic and marital status were also assessed.
Using data from SEER as well as Medicare claims, patients were categorized as having received or not having received stage-appropriate treatment, defined as a minimum surgical reaction for stage I and II disease, chemoradiation or surgical resection for stage III disease and chemotherapy for stage IV.
Overall, patients with IPF had a higher likelihood of being diagnosed at an earlier stage (P < .01), having squamous histology (46% vs. 35%; P < .01) and having lower-lobe tumors (38% vs. 28%; P < .01) than patients without IPF. Both lung cancer-specific (HR = 1.35; 95% CI, 1.26-1.45) and overall survival (HR = 1.21; 95% CI, 1.1-1.32) were worse in individuals with IPF. Patients with advanced disease also had a lower likelihood of being treated (OR = 0.82; 95% CI, 0.68-0.99), but patients with IPF who had stage I or II disease had similar odds of receiving stage-appropriate therapy as patients without IPF who had stage I or II disease (OR = 1.13; 95% CI, 0.89-1.43). Median survival time was also longer in patients without IPF than in patients with IPF (11 vs. 7 months; P < .01).
“There appears to be an important clinical gap that needs to be addressed,” Powell said. “I think further study would be warranted to understand the decision-making process of the pulmonologists and clinicians who make the diagnosis of lung cancer in patients who have concurrent IPF to better understand the reasons that these providers may have had to decide to not refer or to refer patients on for treatment for advanced lung cancer. Our data and those of others showing that the risk of lung cancer is increased in IPF patients support emphasizing enrollment in early detection lung cancer screening programs for eligible patients with lung fibrosis.” – by Eamon Dreisbach
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Charles A. Powell, MD, MBA, can be reached on Twitter: @CAP_MDNY.
Disclosures: Powell reports he has received grants from NIH. Please see the study for all other authors’ relevant financial disclosures.