Main Session
Sep 28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology

2828 - Non-Surgical Management of Patients with Early Stage Non-Small Cell Lung Cancer (NSCLC) A Real-World 20-Year Cohort Study

03:00pm - 04:00pm ET
Poster Hall - Exhibit Hall A
Screen: 31
POSTER

Presenter(s)

Cristina Ou, RT, BS Headshot
Cristina Ou, RT, BS - Midwestern University, AZCOM, Glendale, AZ

C. Ou1, J. Wampfler2, J. Gu3, M. R. Buras4, T. T. W. Sio5, and P. Yang2; 1Midwestern University, AZCOM, Glendale, AZ, United States, 2Mayo Clinic, Rochester, MN, 3Mayo Clinic, Scottsdale, AZ, 4Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, 5Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ

Purpose/Objective(s):

Early-stage lung cancer is most effectively treated with surgical resection; however, a significant subset of patients decline or do not qualify for surgery due to underlying comorbidities and instead undergo radiation therapy with or without systemic therapy. Little is known about the demographic, clinical, and quality-of-life (QOL) characteristics of this non-surgical population compared to those receiving surgery. Understanding these differences is essential for developing treatment strategies and survivorship guidelines tailored to patients who do not undergo surgical intervention. We hypothesized that non-surgical early-stage NSCLC patients would have worse survival and QOL outcomes than surgically treated patients.

Materials/Methods:

A retrospective cohort analysis was conducted of 19,833 lung cancer patients diagnosed between 1997 and 2016 within an institutional epidemiology database. Identified were 6,489 early-stage cases, including 5,364 (83%) treated surgically and 1,121 (17%) treated non-surgically, and performed descriptive analyses of demographics, tumor characteristics, treatment patterns, survival outcomes, and QOL metrics using raw cohort tables. Propensity score matching to surgically treated patients (target n=1,121) and multivariate models will be used in the final analysis to compare survival, recurrence, and QOL between treatment groups.

Results:

Compared to the unmatched surgical group, the non-surgical patients were older (median 74 vs 68 years), more likely to have squamous histology (37% vs 26%), and had higher mortality (92% vs 74%). Non-surgical cases were more frequently diagnosed with stage IIB (19% vs 12%) and primarily received radiation ± systemic therapy (71%), whereas most surgical patients underwent surgery alone (79%). The non-surgical received radiation only (45%) vs systemic therapy (77%), radiation + systemic (19%), or other treatment (2%). A subset of patients that received no treatment (27%). QOL participation (via a questionnaire) was lower in the non-surgical cohort (23% vs 47% in the surgical), and QOL scores were significantly worse overall, physical, and social domains (all p<0.001). Among non-surgical QOL did not differ substantially between those who received radiation ± systemic therapy and those who received no treatment.

Conclusion:

Preliminary findings show that early-stage lung cancer patients who are ineligible for or refuse surgery represent an older, more comorbid, and clinically distinct population with higher mortality and lower reported QOL across several domains. Recognizing these differences highlights the need for tailored therapeutic strategies and survivorship support for patients who decline or are not suitable for surgery.