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Variations in Surgeon Treatment Recommendations for Lobectomy in Early-Stage Non-Small-Cell Lung Cancer by Patient Age and Comorbidity

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices.

Methods

We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations.

Results

Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations.

Conclusions

Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.

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Acknowledgment

This work of the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium was supported by grants from the National Cancer Institute (NCI) to the Statistical Coordinating Center (U01 CA093344) and the NCI-supported Primary Data Collection and Research Centers (Dana Farber Cancer Institute/Cancer Research Network U01 CA093332, Harvard Medical School/Northern California Cancer Center U01 CA093324, RAND/UCLA U01 CA093348, University of Alabama at Birmingham U01 CA093329, University of Iowa U01 CA01013, University of North Carolina U01 CA093326) and by a Department of Veteran's Affairs grant to the Durham VA Medical Center CRS 02-164.

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Authors and Affiliations

  1. Department of Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    Selwyn O. Rogers Jr. MD, MPH

  2. Department of Medical Oncology and the Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA

    Stacy W. Gray MD, AM

  3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Mary Beth Landrum PhD & Nancy L. Keating MD, MPH

  4. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Carrie N. Klabunde PhD & Steven Clauser PhD

  5. RAND Corporation, Santa Monica, CA, USA

    Katherine L. Kahn MD

  6. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Katherine L. Kahn MD & Diana Tisnado PhD

  7. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA

    Robert H. Fletcher MD, MSc

  8. College of Pharmacy, University of Iowa, Iowa City, IA, USA

    William Doucette PhD

  9. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Nancy L. Keating MD, MPH

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  1. Selwyn O. Rogers Jr. MD, MPH
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  2. Stacy W. Gray MD, AM
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  3. Mary Beth Landrum PhD
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  4. Carrie N. Klabunde PhD
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  5. Katherine L. Kahn MD
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  6. Robert H. Fletcher MD, MSc
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  7. Steven Clauser PhD
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  8. Diana Tisnado PhD
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Correspondence to Selwyn O. Rogers Jr. MD, MPH.

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Rogers, S.O., Gray, S.W., Landrum, M.B. et al. Variations in Surgeon Treatment Recommendations for Lobectomy in Early-Stage Non-Small-Cell Lung Cancer by Patient Age and Comorbidity. Ann Surg Oncol 17, 1581–1588 (2010). https://doi.org/10.1245/s10434-010-0946-y

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  • DOI: https://doi.org/10.1245/s10434-010-0946-y

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