Annals of Surgical Oncology

, Volume 17, Issue 6, pp 1581–1588

Variations in Surgeon Treatment Recommendations for Lobectomy in Early-Stage Non-Small-Cell Lung Cancer by Patient Age and Comorbidity

  • Selwyn O. RogersJr.
  • Stacy W. Gray
  • Mary Beth Landrum
  • Carrie N. Klabunde
  • Katherine L. Kahn
  • Robert H. Fletcher
  • Steven Clauser
  • Diana Tisnado
  • William Doucette
  • Nancy L. Keating
Thoracic Oncology

DOI: 10.1245/s10434-010-0946-y

Cite this article as:
Rogers, S.O., Gray, S.W., Landrum, M.B. et al. Ann Surg Oncol (2010) 17: 1581. doi:10.1245/s10434-010-0946-y

Abstract

Background

Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices.

Methods

We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations.

Results

Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations.

Conclusions

Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Selwyn O. RogersJr.
    • 1
  • Stacy W. Gray
    • 2
  • Mary Beth Landrum
    • 3
  • Carrie N. Klabunde
    • 4
  • Katherine L. Kahn
    • 5
    • 6
  • Robert H. Fletcher
    • 7
  • Steven Clauser
    • 4
  • Diana Tisnado
    • 6
  • William Doucette
    • 8
  • Nancy L. Keating
    • 3
    • 9
  1. 1.Department of Surgery and Center for Surgery and Public HealthBrigham and Women’s HospitalBostonUSA
  2. 2.Department of Medical Oncology and the Center for Outcomes and Policy ResearchDana-Farber Cancer InstituteBostonUSA
  3. 3.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  4. 4.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  5. 5.RAND CorporationSanta MonicaUSA
  6. 6.David Geffen School of Medicine at UCLALos AngelesUSA
  7. 7.Department of Ambulatory Care and PreventionHarvard Medical SchoolBostonUSA
  8. 8.College of PharmacyUniversity of IowaIowa CityUSA
  9. 9.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA