Older Patients with Non-small Cell Lung Cancer Face Significant Challenges After Treatment, Study Shows

Older Patients with Non-small Cell Lung Cancer Face Significant Challenges After Treatment, Study Shows

Older patients with early non-small cell lung cancer (NSCLC) can spend an average of one in three days interacting with the healthcare system during the initial 60 days after treatment — either surgery or radiation therapy, a new study shows.

The study, “Treatment Burden of Medicare Beneficiaries With Stage I Non-Small Cell Lung Cancer, was published in the Journal of Oncology Practice.

Treatment burden is a patient-centered quality measure with increasing importance for a rapidly growing geriatric oncology population in an era of value-based cancer care.

“To our knowledge, this is the first study to characterize treatment burden for early-stage lung cancer patients in terms of touches with the healthcare system, including emergency department visits, hospital-based follow-up care, number of physicians, and outpatient visits,” Carolyn Presley, instructor at Yale Cancer Center, a Robert Wood Johnson Clinical Scholar at Yale School of Medicine, and the study’s lead author, said in a news release.

To evaluate treatment burden in a sample of Medicare beneficiaries who were diagnosed with early-stage NSCLC, Presley and her colleagues performed a retrospective analysis of 8,000 patients diagnosed from 2007 to 2011. The patients included in the analysis received treatment for their lung cancer either through surgery (76 percent), stereotactic body radiation therapy (10 percent), or external beam radiation therapy (13 percent).

Researchers looked at the number of days a patient interacted with the healthcare system, the number of doctors responsible for patient care, and the number of medications that patients were prescribed.

Overall, the researchers found that 7,955 patients spent on average of one in three days interacting with the healthcare system in the first 60 days after surgery or radiation therapy. In the 12 months after their treatment, patients had a median of 44 days interacting with the healthcare system.

“These findings highlight a need to improve cancer care coordination. It’s also a call for providers to think about the burden we might be placing on patients,” Presley said.

Patients with a higher number of medical conditions treated with surgery had more after-treatment burdens compared to patients who were treated with stereotactic body radiation therapy or with external beam radiation therapy.

“We found that after a typical treatment for cancer, older patients saw an average of 20 different physicians during multiple visits and took 12 different medications,” Presley said. “These numbers are very high and a lot to expect of older patients who often have mobility issues or functional limitations. With every additional visit and prescription, there is additional room for errors.”

“For older patients who have more comorbidities — chronic conditions, like hypertension or diabetes, etc. — it’s reasonable to strongly consider prescribing SBRT [stereotactic body radiation therapy] vs. surgery or EBRT [external beam radiation therapy]. SBRT radiation involves fewer treatment days,” Presley added.

She said streamlining cancer treatment should be a focus in care so the patient can spend the least amount of time possible interacting with the healthcare system.

“We have to start incorporating the patient voice in treatment decisions and really investing in case management and care coordination,” Presley said. “Reducing the number of visits, scheduling them on the same days, and reducing redundant tests, labs, and medications would greatly improve the daily lives of cancer patients.”

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