Abstract
Small-cell lung cancer (SCLC) is an aggressive disease with poor survival and rapid doubling time. Current practice is to treat SCLC as soon as possible but evidence on appropriate timing of treatment from diagnosis (TTD) is lacking. This is a retrospective analysis of SCLC patients from the 2012 to 2015 Kentucky Cancer Registry. Data collected included age at diagnosis, stage, gender, race, insurance and treatment. Factors and survival associated with TTD were identified with logistic regression analyses and Cox proportional hazards models. Among the 2992 SCLC patients, 2371 (79%) of SCLC patients were treated with one or more treatment modalities. Among treated patients, 93% received chemotherapy ± radiation with the mean TTD of 18 days. Most patients (80%) have TTD of ≤ 4 weeks with 33% treated within 1 week, 20% 1–2 weeks, and 27% 2–4 weeks from diagnosis. Delay in treatment (TTD > 4 weeks) was less in stage III and IV disease (odds ratio: 0.33 and 0.27 respectively, p < 0.01) but not significantly associated with age, race, gender, and insurance. One and two-year survival of patients with TTD ≤ 4 weeks was significantly worse when compared to > 4 weeks (hazard ratio = 1.43, 95% CI 1.2–1.6, p < 0.01; HR = 1.45, 95% CI 1.3–1.6, p < 0.01 respectively). These results show a trend toward better survival with late treatment of SCLC. Therefore, a general urgency to treat SCLC needs to be re-evaluated with consideration of patients needing more optimization before treatment. Further studies are needed to better clarify the appropriate timing of treatment from diagnosis in SCLC and who will benefit from early versus late treatment.
Abbreviations
- SCLC:
-
Small-cell lung cancer
- TTD:
-
Timing of treatment from diagnosis
- OR:
-
Odds ratio
- HR:
-
Hazard ratio
- OS:
-
Overall survival
- KCR:
-
Kentucky cancer registry
References
Gazdar AF, Bunn PA, Minna JD. Small-cell lung cancer: what we know, what we need to know and the path forward. Nat Rev Cancer. 2017;17:725.
Berthelet E, Truong PT, Lesperance M, Lim JT, Wai ES, MacNeil MV, et al. Examining time intervals between diagnosis and treatment in the management of patients with limited stage small cell lung cancer. Am J Clin Oncol. 2006;29(1):21–6.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Small Cell Lung Cancer Version 2.2018; 2018. https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed 5 Aug 2018.
Powell HA, Tata LJ, Baldwin DR, Potter VA, Stanley RA, Khakwani A, et al. Treatment decisions and survival for people with small-cell lung cancer. Br J Cancer. 2014;110:908.
Radzikowska E, Roszkowski-Sliz K, Chabowski M, Glaz P. Influence of delays in diagnosis and treatment on survival in small cell lung cancer patients. Adv Exp Med Biol. 2013;788:355–62.
US National Institutes of Health NCI. State cancer profiles: National Cancer Institute; 2017. https://statecancerprofiles.cancer.gov. Accessed 14 Dec 2018.
Comber H, Cronin DP, Deady S, Lorcain PO, Riordan P. Delays in treatment in the cancer services: impact on cancer stage and survival. Ir Med J. 2005;98(8):238–9.
Kiss N. Nutrition support and dietary interventions for patients with lung cancer: current insights. Lung Cancer. 2016;7:1–9.
Koinis F, Kotsakis A, Georgoulias V. Small cell lung cancer (SCLC): no treatment advances in recent years. Transl Lung Cancer Res. 2016;5(1):39–50.
Funding
This work was supported by the LEADS collaborative, grant from Bristol Myers Squib foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
All the authors declare that they do not have any conflicts of interest in this work.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bhandari, S., Pham, D., Pinkston, C. et al. Timing of treatment in small-cell lung cancer. Med Oncol 36, 47 (2019). https://doi.org/10.1007/s12032-019-1271-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12032-019-1271-3