A matter of comprehensive informed consent: Short-term mortality rates with definitive treatment options in elderly stage i NSCLC

Research output: Contribution to journalArticle

Shraddha M. Dalwadi, Ricky R. Savjani, Eric H. Bernicker, Edward B. Butler, Bin S. Teh, Andrew M. Farach

Background:Although lobectomy is the standard of care in stage I non-small cell lung cancer (NSCLC), medical comorbidities increase surgical risk in elderly patients. No population-based studies compare short-term mortality (STM) for surgery (STM-S), radiation (STM-R), and observation (STM-O) in elderly patients with stage I NSCLC.Methods:A total of 60,466 biopsy-proven stage I NSCLC cases diagnosed between 2004 and 2012 were retrieved from the Surveillance, Epidemiology, and End Results Program. Patient characteristics were compared using χ2 test. Age was divided into 5-year subsets (60 to 64 to 90+ y) for analysis. Similar to other series, STM was defined as death within 2 months of diagnosis. Univariate and multivariate analysis for STM was performed using odds ratio, Kaplan-Meier actuarial method, and Cox proportional hazard ratio.Results:In younger patients, STM-S rates are lower compared with STM-R (1.6% vs. 3.4% in patients 60 to 64 y, P<0.001). However, STM-S rates surpass STM-R with increasing age (up to 8.1% vs. 2.3% in patients 90+ y, P<0.001) becoming significant in the 75- to 79-year age group (4.7% vs. 2.2%, P<0.001). There is an inflection point in the 65- to 69-year age group where STM-S and STM-R rates are similar (2.6% vs. 3.0%, P=0.090). STM for observation reflected the poor health of this cohort with high STM rates in all age groups (19.5% for age 60 to 64 y to 25.3% for age 90+ y, P=0.005). Sex, race, Hispanic ethnicity, age group, and treatment were associated with higher STM on the multivariable analysis (all P<0.001).Conclusion:STM in elderly stage I NSCLC patients treated with surgery increases with advancing age but remains stable for patients receiving radiation. Given the success of stereotactic body radiation therapy, radiation should be considered for patients with high STM risk associated with surgery.

Original languageEnglish (US)
Pages (from-to)851-855
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume42
Issue number11
DOIs
StatePublished - Nov 1 2019

PMID: 31573986

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A matter of comprehensive informed consent : Short-term mortality rates with definitive treatment options in elderly stage i NSCLC. / Dalwadi, Shraddha M.; Savjani, Ricky R.; Bernicker, Eric H.; Butler, Edward B.; Teh, Bin S.; Farach, Andrew M.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 42, No. 11, 01.11.2019, p. 851-855.

Research output: Contribution to journalArticle

Harvard

Dalwadi, SM, Savjani, RR, Bernicker, EH, Butler, EB, Teh, BS & Farach, AM 2019, 'A matter of comprehensive informed consent: Short-term mortality rates with definitive treatment options in elderly stage i NSCLC' American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 42, no. 11, pp. 851-855. https://doi.org/10.1097/COC.0000000000000606

APA

Dalwadi, S. M., Savjani, R. R., Bernicker, E. H., Butler, E. B., Teh, B. S., & Farach, A. M. (2019). A matter of comprehensive informed consent: Short-term mortality rates with definitive treatment options in elderly stage i NSCLC. American Journal of Clinical Oncology: Cancer Clinical Trials, 42(11), 851-855. https://doi.org/10.1097/COC.0000000000000606

Vancouver

Dalwadi SM, Savjani RR, Bernicker EH, Butler EB, Teh BS, Farach AM. A matter of comprehensive informed consent: Short-term mortality rates with definitive treatment options in elderly stage i NSCLC. American Journal of Clinical Oncology: Cancer Clinical Trials. 2019 Nov 1;42(11):851-855. https://doi.org/10.1097/COC.0000000000000606

Author

Dalwadi, Shraddha M. ; Savjani, Ricky R. ; Bernicker, Eric H. ; Butler, Edward B. ; Teh, Bin S. ; Farach, Andrew M. / A matter of comprehensive informed consent : Short-term mortality rates with definitive treatment options in elderly stage i NSCLC. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2019 ; Vol. 42, No. 11. pp. 851-855.

BibTeX

@article{82693e342ef04021bb958efcfe204286,
title = "A matter of comprehensive informed consent: Short-term mortality rates with definitive treatment options in elderly stage i NSCLC",
abstract = "Background:Although lobectomy is the standard of care in stage I non-small cell lung cancer (NSCLC), medical comorbidities increase surgical risk in elderly patients. No population-based studies compare short-term mortality (STM) for surgery (STM-S), radiation (STM-R), and observation (STM-O) in elderly patients with stage I NSCLC.Methods:A total of 60,466 biopsy-proven stage I NSCLC cases diagnosed between 2004 and 2012 were retrieved from the Surveillance, Epidemiology, and End Results Program. Patient characteristics were compared using χ2 test. Age was divided into 5-year subsets (60 to 64 to 90+ y) for analysis. Similar to other series, STM was defined as death within 2 months of diagnosis. Univariate and multivariate analysis for STM was performed using odds ratio, Kaplan-Meier actuarial method, and Cox proportional hazard ratio.Results:In younger patients, STM-S rates are lower compared with STM-R (1.6{\%} vs. 3.4{\%} in patients 60 to 64 y, P<0.001). However, STM-S rates surpass STM-R with increasing age (up to 8.1{\%} vs. 2.3{\%} in patients 90+ y, P<0.001) becoming significant in the 75- to 79-year age group (4.7{\%} vs. 2.2{\%}, P<0.001). There is an inflection point in the 65- to 69-year age group where STM-S and STM-R rates are similar (2.6{\%} vs. 3.0{\%}, P=0.090). STM for observation reflected the poor health of this cohort with high STM rates in all age groups (19.5{\%} for age 60 to 64 y to 25.3{\%} for age 90+ y, P=0.005). Sex, race, Hispanic ethnicity, age group, and treatment were associated with higher STM on the multivariable analysis (all P<0.001).Conclusion:STM in elderly stage I NSCLC patients treated with surgery increases with advancing age but remains stable for patients receiving radiation. Given the success of stereotactic body radiation therapy, radiation should be considered for patients with high STM risk associated with surgery.",
keywords = "lung cancer, radiation, surgery",
author = "Dalwadi, {Shraddha M.} and Savjani, {Ricky R.} and Bernicker, {Eric H.} and Butler, {Edward B.} and Teh, {Bin S.} and Farach, {Andrew M.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/COC.0000000000000606",
language = "English (US)",
volume = "42",
pages = "851--855",
journal = "American Journal of Clinical Oncology: Cancer Clinical Trials",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

RIS

TY - JOUR

T1 - A matter of comprehensive informed consent

T2 - American Journal of Clinical Oncology: Cancer Clinical Trials

AU - Dalwadi, Shraddha M.

AU - Savjani, Ricky R.

AU - Bernicker, Eric H.

AU - Butler, Edward B.

AU - Teh, Bin S.

AU - Farach, Andrew M.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background:Although lobectomy is the standard of care in stage I non-small cell lung cancer (NSCLC), medical comorbidities increase surgical risk in elderly patients. No population-based studies compare short-term mortality (STM) for surgery (STM-S), radiation (STM-R), and observation (STM-O) in elderly patients with stage I NSCLC.Methods:A total of 60,466 biopsy-proven stage I NSCLC cases diagnosed between 2004 and 2012 were retrieved from the Surveillance, Epidemiology, and End Results Program. Patient characteristics were compared using χ2 test. Age was divided into 5-year subsets (60 to 64 to 90+ y) for analysis. Similar to other series, STM was defined as death within 2 months of diagnosis. Univariate and multivariate analysis for STM was performed using odds ratio, Kaplan-Meier actuarial method, and Cox proportional hazard ratio.Results:In younger patients, STM-S rates are lower compared with STM-R (1.6% vs. 3.4% in patients 60 to 64 y, P<0.001). However, STM-S rates surpass STM-R with increasing age (up to 8.1% vs. 2.3% in patients 90+ y, P<0.001) becoming significant in the 75- to 79-year age group (4.7% vs. 2.2%, P<0.001). There is an inflection point in the 65- to 69-year age group where STM-S and STM-R rates are similar (2.6% vs. 3.0%, P=0.090). STM for observation reflected the poor health of this cohort with high STM rates in all age groups (19.5% for age 60 to 64 y to 25.3% for age 90+ y, P=0.005). Sex, race, Hispanic ethnicity, age group, and treatment were associated with higher STM on the multivariable analysis (all P<0.001).Conclusion:STM in elderly stage I NSCLC patients treated with surgery increases with advancing age but remains stable for patients receiving radiation. Given the success of stereotactic body radiation therapy, radiation should be considered for patients with high STM risk associated with surgery.

AB - Background:Although lobectomy is the standard of care in stage I non-small cell lung cancer (NSCLC), medical comorbidities increase surgical risk in elderly patients. No population-based studies compare short-term mortality (STM) for surgery (STM-S), radiation (STM-R), and observation (STM-O) in elderly patients with stage I NSCLC.Methods:A total of 60,466 biopsy-proven stage I NSCLC cases diagnosed between 2004 and 2012 were retrieved from the Surveillance, Epidemiology, and End Results Program. Patient characteristics were compared using χ2 test. Age was divided into 5-year subsets (60 to 64 to 90+ y) for analysis. Similar to other series, STM was defined as death within 2 months of diagnosis. Univariate and multivariate analysis for STM was performed using odds ratio, Kaplan-Meier actuarial method, and Cox proportional hazard ratio.Results:In younger patients, STM-S rates are lower compared with STM-R (1.6% vs. 3.4% in patients 60 to 64 y, P<0.001). However, STM-S rates surpass STM-R with increasing age (up to 8.1% vs. 2.3% in patients 90+ y, P<0.001) becoming significant in the 75- to 79-year age group (4.7% vs. 2.2%, P<0.001). There is an inflection point in the 65- to 69-year age group where STM-S and STM-R rates are similar (2.6% vs. 3.0%, P=0.090). STM for observation reflected the poor health of this cohort with high STM rates in all age groups (19.5% for age 60 to 64 y to 25.3% for age 90+ y, P=0.005). Sex, race, Hispanic ethnicity, age group, and treatment were associated with higher STM on the multivariable analysis (all P<0.001).Conclusion:STM in elderly stage I NSCLC patients treated with surgery increases with advancing age but remains stable for patients receiving radiation. Given the success of stereotactic body radiation therapy, radiation should be considered for patients with high STM risk associated with surgery.

KW - lung cancer

KW - radiation

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85074119131&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074119131&partnerID=8YFLogxK

U2 - 10.1097/COC.0000000000000606

DO - 10.1097/COC.0000000000000606

M3 - Article

VL - 42

SP - 851

EP - 855

JO - American Journal of Clinical Oncology: Cancer Clinical Trials

JF - American Journal of Clinical Oncology: Cancer Clinical Trials

SN - 0277-3732

IS - 11

ER -

ID: 55584642