Assessment of Treatment Strategies for Stage I Non-small Cell Lung Cancer in Patients with Comorbidities

Menée à partir des données des registres américains des cancers et de la base Medicare, cette étude analyse les différentes stratégies thérapeutiques pour prendre en charge les patients atteints d'un cancer du poumon non à petites cellules de stade I et présentant des comorbidités

Résumé en anglais

Introduction : Non-small cell lung cancer (NSCLC) patients frequently have major comorbidities butthere is scarce data regarding the impact of these conditions on management strategies.We used simulation modeling to compare different treatments for stage I NSCLC forpatients with common major comorbidities.

Methods : We used data on NSCLC patinet outcomes and quality of life from: (1) the SurveillanceEpidemiology and End Results (SEER) database linked to Medicare claims; (2) KaiserPermanente Southern California electronic health records; and (3) SEER-Medical Health Outcomes Survey to parameterize a novel simulation model of management and outcomesfor stage I NSCLC. Relative efficacy of treatment modalities (lobectomy, segmentectomy,wedge resection and stereotactic body radiotherapy [SBRT]) was collected from existingliterature and combined using evidence synthesis methods. We then simulated multiple randomized trials comparing these treatments in a variety of scenarios, estimating quality adjusted life expectancy (QALE) according to age, tumor size, histologic subtype,and comorbidity status.

Results : Lobectomy and segmentectomy yielded the greatest QALE gains among all simulated age,tumor size and comorbidity groups. Optimal treatment strategies differed by patientsex and age; wedge resection was among the optimal strategies for women aged 80-84with tumors 0-2 cm in size. SBRT was included in some optimal strategies for patientsaged 80-84 with multimorbidity.

Conclusions : In simulated comparative trials of four common treatments for stage I NSCLC, aggressivesurgical management was typically associated with the greatest projected QALE gainsdespite the presence of comorbidities, although less aggressive strategies were predictedto be non-inferior in some older comorbid patient groups.