NEW YORK – What is the best strategy for managing veterans with stage 1 non-small cell lung cancer with co-morbid chronic obstructive pulmonary disease or coronary artery disease?
A study team led by researchers from the James J. Peters VAMC, the Icahn School of Medicine at Mount Sinai, and the Columbia University School of Medicine decided to find out. Their results were published in PLoS One.1
Researchers noted that veterans are at increased risk of lung cancer and that their treatment is especially complex because many also have comorbidities such as COPD and CAD. The study team used simulation modeling to assess projected outcomes associated with different management strategies of veterans with stage I non-small cell lung cancer (NSCLC) with COPD and/or CAD.
Data came from a cohort of 14,029 Veterans (years 2000-2015) with NSCLC. Using a well-validated mathematical model of lung cancer, researchers simulated multiple randomized trials to compare treatment with lobectomy, limited resection, or stereotactic body radiation therapy (SBRT). They also estimated expected quality-adjusted life years (QALY) of veterans with stage I NSCLC according to age, tumor size, histologic subtype, COPD severity, and CAD diagnosis.
Results indicated that, for veterans younger than 70 years old, lobectomy was associated with greater projected quality-adjusted life expectancy regardless of comorbidity status. On the other hand, the authors wrote, “For most combinations of tumors and comorbidity profiles there was no dominant treatment for veterans ≥80 years of age, but less invasive treatments were often superior to lobectomy. Dominant treatment choices differed by CAD status for older patients in a third of scenarios, but not for patients <70 years old.”
Researchers pointed out that the harm/benefit ratio of treatments for stage I NSCLC among veterans appears to differ according to COPD severity and the presence of CAD. “This information can be used to direct future research study design for veterans with stage I lung cancer and COPD and/or CAD,” they added.
- Sigel K, Kong CY, Rehmani S, Bates S, et. Al. Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities. PLoS One. 2021 Mar 18;16(3):e0248067. doi: 10.1371/journal.pone.0248067. PMID: 33735217; PMCID: PMC7971489.