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      Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent?

      Lawrenson, Ross; Lao, Chunhuan; Brown, Leonie; Moosa, Lucia; Chepulis, Lynne Merran; Keenan, Rawiri; Kidd, Jacquie; Middleton, Karen; Conaglen, Paul; de Groot, Charles; Aitken, Denise; Wong, Janice
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      Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent.pdf
      Published version, 896.4Kb
      DOI
       10.1186/s12885-020-6580-6
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      Lawrenson, R., Lao, C., Brown, L., Moosa, L., Chepulis, L., Keenan, R., … Wong, J. (2020). Management of patients with early stage lung cancer - why do some patients not receive treatment with curative intent? BMC Cancer, 20(1), 109. https://doi.org/10.1186/s12885-020-6580-6
      Permanent Research Commons link: https://hdl.handle.net/10289/13484
      Abstract
      BACKGROUNDS: This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment.

      METHODS: Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death.

      RESULTS: In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8-91.8%) and 5-year survival of 69.6% (95% CI: 63.2-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori.

      CONCLUSIONS: The majority of patients with stage I and II lung cancer are managed with potentially curative treatment - mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.
      Date
      2020
      Type
      Journal Article
      Rights
      © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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