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Lung cancer is the second most common cancer and the leading cancer-related cause of death in both men and women. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, comprising approximately 84% of all lung cancer. Approximately half of patients with NSCLC are diagnosed at an advanced stage when survival rates are very poor (5 year survival of 4.5% for distant disease). Systemic therapies are the primary treatment for patients with advanced-stage disease. In the past two decades, many new systemic therapies have been developed. These treatments have been shown to increase survival in clinical trials, but their use and effectiveness at the population-level is unknown. The present study was based on data collected by the California Cancer Registry (CCR), California’s statewide cancer surveillance system. The CCR collects types of systemic treatment in an unstructured free-text format. In Chapter 1, we manually reviewed treatment text fields in the CCR to determine first-line systemic therapies used in patients with stage IV NSCLC and associations with survival. Chapter 2 explored the relationship between systemic therapy use and source of health insurance. Finally, in Chapter 3, we developed a SAS-based text mining algorithm to extract treatment information from unstructured free-text fields and compared the results to manual review. Our findings indicate that the treatments associated with a significant survival advantage (tyrosine kinase inhibitors and bevacizumab combinations versus platinum doublets) for advanced-stage nonsquamous NSCLC were underutilized among the over 14,000 patients included in our study. Substantial disparities in the use of systemic therapies exist by health insurance type in California. Patients with Medicaid, military, or no insurance have significantly decreased odds of receiving tyrosine kinase inhibitors, bevacizumab combinations, or any systemic treatment at all. Our SAS-based text mining algorithm accurately detected systemic treatments administered to stage IV NSCLC patients, with Kappa ranging from 0.71 to 0.92, and may become a viable alternative to the considerable time involved in manual review of patient records. Our algorithm can be applied to other cancer types, potentially maximizing the utility of extant information in cancer registries for comparative effectiveness research.
Lung cancer is the leading cause of cancer mortality worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85% of all cases of lung cancer. Most patients present with advanced disease and five-year survival is low at about 15%. Surgery is the main treatment for early stage disease. If patients are deemed inoperable, systemic chemotherapy is considered. For patients with locally advanced disease, multimodality therapy is administered where chemotherapy is given in combination with definitive radiation therapy or surgery in selected cases. Cytotoxic chemotherapy regimens mainly consist of a platinum doublet. Biologic agents are increasingly being incorporated into treatment regimens. This pocketbook summarises the latest evidence-based and practical information on the use of systemic therapies in the management of non-small cell lung cancer (NSCLC), for early stage, locally advanced, and metastatic disease. Including contributions from leading thoracic oncologists from North America and Europe, the book covers the range of therapies currently available to clinicians including cytotoxic chemotherapy, biologic therapies, and other novel agents. This book will serve as an invaluable reference for all health care professionals involved in the management of patients with NSCLC.
This issue of Thoracic Surgery Clinics, guest edited by Drs. Jyoti Patel and Jessica Donington, is devoted to Advances in Systemic Therapy for Non-Small Cell Lung Cancer. Drs. Patel and Donington have assembled expert authors to review the following topics: Adjuvant and Neoadjuvant Immunotherapy; Combining Immunotherapy with Radiation in Lung Cancer; Adjuvant Chemotherapy; ALK Mutations; Molecular Targets Beyond the Big 3; Advances in Systemic Therapy; Liquid Biopsies in NSCLC; Combining Immunotherapy and Chemotherapy for NSCLC; ROS-1 Mutations; EGFR Mutations; and more!
Access comprehensive, multidisciplinary guidance on the diagnosis and treatment of lung cancer! This new resource addresses the full range of clinical issues in diagnosis, staging, and treatment, as well as the latest scientific data and evidence-based guidelines. A user-friendlyorganization provides quick reference to data summaries, as well as more comprehensive and detailed information for readers who wish to explore topics in depth. Features contributions by authors from many different disciplines, to ensure a balanced approach. Addresses the clinical issues seen in practice, with the inclusion of basic science research topics that are likely to be put into clinical practice soon. Integrates evidence-based medicine throughout. Assesses the strength of all available dataenabling readers to weigh different arguments and make decisions based on medical issues, values, and the availability and efficacy of interventionsusing a data rating system. Addresses difficult, but clinically relevant issues for which limited data is available. Enables readers to quickly reference findings and data in data summary statements and summary tables.
Lung cancer is the leading cause of cancer mortality worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85% of all cases of lung cancer. Most patients present with advanced disease and five-year survival is low at about 15%. Surgery is the main treatment for early stage disease. If patients are deemed inoperable, systemic chemotherapy is considered. For patients with locally advanced disease, multimodality therapy is administered where chemotherapy is given incombination with definitive radiation therapy or surgery in selected cases. Cytotoxic chemotherapy regimens mainly con.