Impact of rates of referral and systemic therapy on 1-year outcomes in metastatic NSCLC: A real-world population based study

• Published in: Journal of clinical oncology Vol. 37; no. 15_suppl; p. e18238
• Main Authors: Fundytus, Adam Michael, Fu, Yunting, Shack, Lorraine, Pham, Truong-Minh, Cheung, Winson Y.
• Format: Journal Article
• Language: English
• Published: 20.05.2019
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2019.37.15_suppl.e18238

Abstract only e18238 Background: EGFR/ALK inhibitors and immunotherapy represent promising treatments for metastatic NSCLC, but patients must be referred to a cancer center (CC) to be considered for these treatments. Local referral rates to a CC for advanced pancreatic cancer are only 51%. We hypothesized that rates of referral for stage IV NSCLC are also low, thereby affecting survival. Methods: Using linked data from the provincial cancer registry, oncology specific EMR, administrative claims and vital statistics, we identified all patients diagnosed with stage IV NSCLC from 2009 to 2016 in Alberta, Canada. Demographics, Charlson Comorbidity Index (CCI), method of diagnosis, year of diagnosis and site of metastasis were compared between patients referred vs not referred (NR) to a CC and between those who received systemic therapy (ST) vs those who did not. A multivariable piecewise constant hazard model was constructed to estimate the hazard ratio (HR) of death in the 1 st year. Results: We identified 9717 stage IV NSCLC patients among whom 65.8% and 34.2% were diagnosed pre and post 2012. In this cohort, 6907 (71%) were seen at a CC. Factors which predict referral to a cancer center are: dx by cytology (OR 6.81, 95% CI: 5.99-7.75; p < 0.001) or histology (OR 6.29, 95% CI: 5.40-7.34; p < 0.001) vs radiologic dx; Age < 70 (OR 1.87, 95% CI: 1.69-2.07; p < 0.001); dx after 2012 (OR 1.52, 95% Cl 1.36-1.70; p < 0.001) and CCI≤1 (OR 1.50, 95% Cl 1.34-1.68; p < 0.001). ST was administered to 2057(21.2%). Factors that predict ST are: dx by cytology (OR 6.48, 95% CI: 5.18-8.11; p < 0.001) or histology (OR 6.35.18 , 95% CI: 5.02-8.04; p < 0.001); Age < 70 (OR 2.55, 95% Cl 2.33-2.82; p < 0.001); CCI≤1 (OR 1.56, 95% Cl 1.39-1.76; p < 0.001); dx after 2012 (OR 1.28, 95% CI: 1.16-1.41 and female gender (OR 1.18 , 95% CI: 1.07-1.29; p < 0.001; p < 0.001). Within the 1 st year post dx, HR for mortality was lower both in patients referred to a CC vs NR (HR 0.3, 95%CI .28-0.31, p < 0.0001) and patients receiving ST vs no ST (HR 0.3, 95% CI .28-0.32, p < 0.0001). Conclusions: Close to 1 in 3 patients with stage IV NSCLC were not referred to a CC even though referral and receipt of ST were associated with a significantly lower risk of death in the 1 st year following diagnosis. Clear delineation and wide dissemination of appropriate referral pathways are needed to improve outcomes, especially among older patients.