Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.
Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.
Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.
Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.