Veterans who do not receive treatment for early-stage non-small cell lung cancer (NSCLC) because of poor performance status have worse overall survival compared with patients who do receive treatment, according to a poster abstract presented at the Association of VA Hematology/Oncology (AVAHO) Annual Meeting. 

“Regardless of treatment, patients above the age of 60 (41% vs 13.4%, p<0.05) and those with poor performance status (19.6% vs 5.8%, p<0.05) had worse 5-year survival, with the effect being greater in the treatment group,” reported researchers from Albany Medical Center and Albany Stratton VA Medical Center. 

The finding stemmed from an analysis of data for 31,966 veterans with stage 0 or 1 NSCLC from a Veterans Affairs Central Cancer Registry. Among them, 83.16% received treatment and 9.68% did not receive treatment. Because an absence of treatment for early-stage NSCLC is linked with worse overall survival, researchers were interested in factors associated with treatment. 

According to the study, patients with Eastern Cooperative Oncology Group (ECOG) performance scores of III and IV, indicating poorer performance status, received less treatment with any modality compared with patients with ECOG performance scores of I and II. In the no-treatment group, 15.07% of patients had poor performance status compared with just 4.03% in the treatment group. 

Overall, rates of 5-year overall survival were higher for the treatment group (43.1%) compared with the no-treatment group (14.7%), researchers reported.  

Analysis showed no clinically significant differences in overall survival by race (Caucasian vs African American) or tumor location (upper, middle, or lower lobe) between the treatment and no-treatment groups. 

A lack of patient-level data, such as why a person did not receive treatment, was a study limitation, researchers noted. 

“Further investigation is required to assess what other criteria are used to decide treatment eligibility,” they wrote, “and whether these patients would be candidates for immunotherapy or targeted therapy in the future.” 

Reference:

Ajmal Z, Moiz Khan A, Tuz Zahra F, Gemoets DE, Mehdi S. Survival analysis of untreated early-stage non-small cell lung cancer (NSCLC) in veteran population. Abstract presented at Association of VA Hematology/Oncology (AVAHO) Annual Meeting; September 24-26, 2021.