Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity

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

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Prior research suggests that older patients are less likely to undergo resection of early-stage nonsmall- 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.

Original languageEnglish (US)
Pages (from-to)1581-1588
Number of pages8
JournalAnnals of Surgical Oncology
Volume17
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Comorbidity
Chronic Obstructive Pulmonary Disease
Therapeutics
Carcinoma
Lung
Surgeons
Lung Diseases
Logistic Models
Smoking
Clinical Trials

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Rogers, S. O., Gray, S. W., Landrum, M. B., Klabunde, C. N., Kahn, K. L., Fletcher, R. H., ... Keating, N. L. (2010). Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity. Annals of Surgical Oncology, 17(6), 1581-1588. https://doi.org/10.1245/s10434-010-0946-y

Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity. / Rogers, Selwyn O.; Gray, Stacy W.; Landrum, Mary Beth; Klabunde, Carrie N.; Kahn, Katherine L.; Fletcher, Robert H.; Clauser, Steven; Tisnado, Diana; Doucette, William; Keating, Nancy L.

In: Annals of Surgical Oncology, Vol. 17, No. 6, 06.2010, p. 1581-1588.

Research output: Contribution to journalArticle

Rogers, SO, Gray, SW, Landrum, MB, Klabunde, CN, Kahn, KL, Fletcher, RH, Clauser, S, Tisnado, D, Doucette, W & Keating, NL 2010, 'Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity', Annals of Surgical Oncology, vol. 17, no. 6, pp. 1581-1588. https://doi.org/10.1245/s10434-010-0946-y
Rogers, Selwyn O. ; Gray, Stacy W. ; Landrum, Mary Beth ; Klabunde, Carrie N. ; Kahn, Katherine L. ; Fletcher, Robert H. ; Clauser, Steven ; Tisnado, Diana ; Doucette, William ; Keating, Nancy L. / Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 6. pp. 1581-1588.
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abstract = "Background. Prior research suggests that older patients are less likely to undergo resection of early-stage nonsmall- 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.",
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AU - Rogers, Selwyn O.

AU - Gray, Stacy W.

AU - Landrum, Mary Beth

AU - Klabunde, Carrie N.

AU - Kahn, Katherine L.

AU - Fletcher, Robert H.

AU - Clauser, Steven

AU - Tisnado, Diana

AU - Doucette, William

AU - Keating, Nancy L.

PY - 2010/6

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N2 - Background. Prior research suggests that older patients are less likely to undergo resection of early-stage nonsmall- 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.

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