Advanced NSCLC: chemotherapy, radiation refusal rates rise

  • Clin Lung Cancer

  • Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Despite improvements in survival rates in advanced NSCLC, more patients are refusing radiation and chemotherapy than in the past, with strong associations with insurance status and race/ethnicity.

Why this matters

  • While targeted agents and immunotherapy have proven effective in the treatment of advanced NSCLC, radiation and chemotherapy remain a key element in disease treatment.

Study design

  • 341,993 patients diagnosed with stage IV NSCLC between 2004-2014 from the National Cancer Database.
  • Funding: Mayo Clinic.

Key results

  • Among all eligible patients, 5.4% refused radiation and 10.3% refused chemotherapy.
  • Treatment refusal increased during the study period (radiation: 4.2% to 7.3% and chemotherapy: 7.9% to 15%; P<.001 for both>
  • Radiation and chemotherapy refusal was more common for patients with Medicaid (aOR, 1.97 and 2.17, respectively), Medicare (aOR, 1.26 and 1.17), or no insurance (aOR, 2.28 and 2.44; P<.001 for all>
  • Compared to whites, radiation refusal was less likely among blacks (aOR, 0.58; P=.03), Hispanics (aOR, 0.55; P=.23), Asians (aOR, 0.26; P=.03), and other (aOR, 0.46; P=.42).
  • Chemotherapy refusal was less likely among Hispanics (aOR, 0.83; P=.14), Asians (aOR, 0.54; P<.001 and other p>

Limitations

  • Retrospective study.