REFERRAL OF LUNG CANCER PATIENTS TO SPECIALIZED CLINICAL ONCOLOGY CARE: INSTITUTO DO CANCER DO ESTADO DE SAO PAULO 2010-2011

Abstract

Background: Lung cancer is the leading cause of death from malignancy in Western countries. To achieve better outcomes and improve quality of care, it is essential to know both patients and disease characteristics. Here we aim to describe epidemiological and tumor characteristics and their impact on survival outcomes, of patients admitted at Instituto do Câncer de Estado de São Paulo (ICESP) between January 2010 and July 2011. Methods: It is a retrospective, descriptive, and uninstitutional study, of patients diagnosed histologically with lung cancer, consecutively admitted at ICESP between January 2010 and July 2011. Overall survival was the main endpoint. Frequencies were compared using chi-square test. Survival was estimated using the Kaplan-Meier methods, and the curves were compared by the log-rank test. This study was approved by the local IRB. Results and Conclusion: 232 patients (pts) were included in this analysis: median age 65y (24-91), 57% male, 56% ECOG 0 - 1, and 83% previous or current smokers. Non small cell lung cancer (NSCLC) was the most common histologic type (213 pts, 92%). Small cell lung cancer (SCLC) was diagnosed in 18 pts (7.6%) and only one (0.4%) was a case of a carcinoid tumor. Regarding NSCLC histologic subtypes, adenocarcinoma was the most common (130 pts, 61%), followed by squamous cell carcinoma (63 pts, 30%) and large cell carcinoma (5 pts, 2%). In 17 pts (7%), it was not possible to determine the subtype, even with immunohistochemistry. In terms of staging, 155 pts (71%) with NSCLC presented metastatic disease (stage IV) at diagnosis, 27 pts (12%) were staged as IIIB, 15 pts (10%) IIIA, 8 pts (3.5%) II and 8 pts (3.5%) I. Among patients with SCLC, six (33%) had localized disease (LD) and 12 (67%) had extensive disease (ED). Analyzing only stage IV NSCLC pts, 123 (79%) were treated with first line chemotherapy, 56 (36%)with second line and 13 (8%) with third line systemic therapies; ECOG 0 - 2 NSCLC pts were more likely to be exposed to second-line therapies (46% vs 36%; p = 0.0002). In a median follow-up of 9.5 mo, median overall survival (mOS) was 9 mo for all pts in this analysis. Regarding NSCLC, in patients with stage I and II mOS was not reached (100% and 68% in 2 years for stage I and II, respectively). In patients with stage IIIA, IIIB and IV, the median OS was 15.2, 11.4 and 7 mo, respectively (p-trend = 0.0002). According to ECOG-PS, mOS was 11.3, 6.3, 4.1, and 2.2 mo for NSCLC pts with ECOG 1, 2, 3 and 4, respectively (p-trend < 0.0001). For SCLC pts, mOS was 12.9 mo among those with LD versus 4.9 mo in ED (HR 3.1; 95% CI 1.1 - 8.6; p = 0.02). Lung cancer survival rate remains poor. As expected, clinical stage and performance status were important prognostic factors. Primary prevention strategies (quitting smoking) and early diagnosis (screening) may be useful in this scenario.