Factors associated with early mortality in non-small cell lung cancer patients following systemic anti-cancer therapy: A 10 year population-based study. (August 2019)

• Record Type: Journal Article
• Authors: Gibson, Amanda J.W.; Li, Haocheng; D'Silva, Adrijana; Elegbede, Anifat A.; Tudor, Roxana A.; Otsuka, Shannon; Bebb, D. Gwyn; Cheung, Winson Y.
• Is Part Of: Lung cancer. Volume 134(2019)
• Page Start: 141
• Page End: 146
• Publication Date: 2019-08
• Subjects: Non-small cell lung cancer -- Mortality -- Systemic anti-cancer therapy -- Avoidable harm -- EGFR; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2019.06.003
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: 30-day mortality rate in real-world populations identifies those at risk of death. 30-day mortality highest in males, palliative, advanced stage and targeted treatment. 30-day mortality rates after systemic therapy decreased in more recent years. 30-day mortality rates may fluctuate as treatment modalities evolve. Abstract: Objectives: To investigate how clinical, demographic and treatment-related factors in non-small cell lung cancer (NSCLC) patients impact the risk of mortality in the 30 days following receipt of systemic anti-cancer therapies (SACT), and undertake a comprehensive review of the treatment decisions and experiences of a real-world population. Materials and methods: We reviewed NSCLC patients receiving SACT from 2005 to 2014, and captured in the Glans-Look Lung Cancer Database, which contains demographic, clinical, pathological, treatment and outcome data. The 30-day post-SACT mortality rate was calculated, and regimen changes in the last 14 days of life were identified. Univariate analysis and multivariate logistic regression were used to identify demographic, tumor and treatment-related factors that correlated with mortality risk. Results: 1044 patients receiving ≥ 1 cycle of SACT in 2005–2014 were identified. 233 (22.3%) deaths occurred ≤ 30 days following SACT receipt; 32 (13.7%) of which had new SACT regimens ≤ 14 days prior to death. Risk of 30-day mortality and regimen changes at the end of life increased in association with being male [OR: 1.48 (1.12–1.95), p = 0.005], advanced disease at diagnosis [OR: 1.85 (1.19–2.88), p = 0.006], palliative-intent treatment [OR: 6.75 (3.88–11.77), p < 0.001], and use of EGFR-targeting agents [OR: 4.5 (3.27–6.18) p < 0.001]. Risk of early mortality decreased for never-smokers [OR: 0.62 (0.41–0.95), p = 0.028], and those receiving SACT in more recent years (2010–2014) [OR: 0.65 (0.49–0.86), p = 0.002]. Conclusion: Our findings identified several factors that affected the risk of early mortality in NSCLC patients following SACT. These results from a representative population provide insights regarding the benefits and risks of SACT and can serve to inform clinical and palliative best practices.