Increasing access to medical oncology consultation in older patients with stage II-IIIA non-small-cell lung cancer

Background: Resectable non-small-cell lung cancer (NSCLC) was once considered a disease whose sole therapy was surgical resection. Therefore it was managed by surgeons. However, with growing evidence of the benefit of adjuvant chemotherapy, such patients should also be evaluated by a medical oncologist. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, we identified 3,196 patients 66-85 years of age with stage II or IIIA NSCLC who underwent resection between 1992 and 2002 in the United States. We examined the trend in medical oncology consultation to identify predictors associated with oncology consultation and subsequent use of adjuvant chemotherapy, using modified Poisson regression. Results: From 1992 to 2002, 1,521 patients (47.6%) with resected stage II or IIIA NSCLC were seen by a medical oncologist within 4 months of diagnosis. Strong predictors for medical oncology referral included: being younger, married, having an advanced tumor, adenocarcinoma histology, receiving radiation, and certain SEER geographic regions. The proportion of patients seen by a medical oncologist more than doubled over the ten-year study period, from 28.4% in 1992 to 57.7% in 2002 (P < 0.001). The use of adjuvant chemotherapy rose similarly in this population. Chemotherapy use varied significantly by patient characteristics, including age, marital status, and geographic region. This variation decreased, however, when analysis was restricted to those seen by a medical oncologist within four months of diagnosis. Conclusions: Our results demonstrate that the role of a medical oncologist as part of the multidisciplinary management of resected NSCLC increased over time, greatly reducing variation in NSCLC management.