• Copyright © 2011 by American Society of Clinical Oncology

Patterns of Care for Non–Small-Cell Lung Cancer at an Academic Institution Affiliated With a National Cancer Institute–Designated Cancer Center

1. Kim-Son H. Nguyen, MD, MPA,
2. Rachel A. Sanford, MD,
3. Mark S. Huberman, MD,
4. Michael A. Goldstein, MD,
5. Danielle M. McDonald, RN,
6. Mary Farquhar, RN,
7. Sidharta P. Gangadharan, MD,
8. Michael S. Kent, MD,
9. Gaetane Michaud, MD,
10. Adnan Majid, MD,
11. Stuart M. Berman, MD,
12. Joseph A. Aronovitz, MD, PhD,
13. Elena A. Nedea, MD,
14. Phillip M. Boiselle, MD,
15. David W. Cohen, MD,
16. Susumu Kobayashi, MD, PhD and
17. Daniel B. Costa, MD, PhD⇓

+ Author Affiliations

1. Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA

1. Corresponding author: Daniel B. Costa, MD, PhD, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: dbcosta@bidmc.harvard.edu.

Abstract

Purpose: Evidence-based treatment guidelines for non–small-cell lung cancer (NSCLC) exist to improve the quality of care for patients with this disease. However, how often evidence-based decisions are used for care of NSCLC is poorly understood.

Patients and Methods: We examined patterns of care and rate of adherence to evidence-based guidelines for 185 new NSCLC patients seen between 2007 and 2009. Evidence-based care status was determined for 150 patients.

Results: Eighty-one percent of the patients were white, the mean age was 66 years, 49% were women, 11% were never smokers, 83% had Eastern Cooperative Oncology Group performance status 0 to 1, 49.7% of tumors were adenocarcinomas, 57.1% of never smokers had tumors genotyped (EGFR, ALK, KRAS), and 13.3% participated in clinical trials. The rate of evidence-based treatment adherence was 94.1% (16 of 17), 100% (21 of 21) and 100% (36 of 36) in patients with stages I, II, and III NSCLC, respectively. Stage IV disease, with adherence of 76.3% (58 of 76), was correlated with a higher rate of nonadherence when compared with stages I-III (odds ratio 16.33; 95% CI, 1.94 to 137.73). In patients with stage IV disease, the rate of evidence-based adherence was 95% (72 of 76) for first-line therapy, 95.2% (40 of 42) for second-line therapy, and only 33.3% (6 of 18) for third-line therapy (P < .001). There was no significant correlation between evidence-based adherence status and the patient's age, sex, performance status, smoking history, ethnicity, or the treating physician.

Conclusion: These data point toward the need for improved evidence-based use of resources in the third-line setting of stage IV NSCLC.

• Accepted June 6, 2011.

Patterns of Care for Non–Small-Cell Lung Cancer at an Academic Institution Affiliated With a National Cancer Institute–Designated Cancer Center