Patients With Small Cell Lung Cancer Often Unable to Receive Standard-of-Care Therapy

01/04/18

A recent study identified substantial barriers to standard-of-care therapy for limited-stage small cell lung cancer (SCLC), including government insurance coverage.

Results of the study were published in JAMA Oncology (online December 4, 2017; doi:10.1001/jamaoncol.2017.4504).

Combined-modality therapy for limited-stage SCLC (chemotherapy and radiation therapy) is considered standard of care as an upfront treatment strategy. However, there may be barriers to utilization in the United States, and further research is necessary to better define these potential barriers.

Todd A Pezzi, MD, division of radiation oncology, University of Texas MD Anderson Cancer Center (Houston, TX), and colleagues conducted an analysis to estimate the utilization rates and factors associated with combined-modality therapy for limited-stage SCLC. Researchers used the National Cancer Database to identify 70,247 cases of limited-stage SCLC from 2004 through 2013.

The main outcome of the study was utilization rates of chemotherapy and radiation therapy at the time of initial treatment. A separate multivariable analysis was used to identify independent clinical and socioeconomic factors associated with utilization and overall survival.

Researchers noted that among the total patient population, initial treatment was 55.5% chemotherapy and radiation therapy, 20.5% chemotherapy alone, 3.5% radiation therapy alone, and 20.0% neither. Median survival was 18.2 months (95% CI, 17.9-18.4), 10.5 months (95% CI, 10.3-10.7), 8.3 months (95% CI, 7.7-8.8), and 3.7 months (95% CI, 3.5-3.8), respectively.

The multivariable analysis showed that being uninsured was associated with a lower likelihood of both chemotherapy (odds ratio, 0.65; 95% CI, 0.56-0.75; P < .001) and radiation therapy (odds ratio, 0.75; 95% CI, 0.67-0.85; P < .001) administration. Medicare or Medicaid insurance did not impact chemotherapy use, whereas Medicaid (odds ratio, 0.79; 95% CI, 0.72-0.87; P < .001) and Medicare (odds ratio, 0.86; 95% CI, 0.82-0.91; P < .001) were independently associated with a lower likelihood of radiation therapy administration.

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Researchers reported that after adjusted analysis, lack of health insurance, Medicaid, and Medicare were independently associated with shorter survival, while chemotherapy and radiation therapy were associated with a survival benefit.

Dr Pezzi and colleagues concluded that the lack of radiation therapy administration was associated with government insurance coverage, which suggests a need for targeted access improvement in patients with limited-stage SCLC. “Additional work will be necessary to conclusively define exact population patterns, specific treatment deficiencies, and causative factors leading to heterogeneous care delivery,” they wrote.—Zachary Bessette