Survival benefits associated with surgery for advanced non-small cell lung cancer.

OBJECTIVE: Overall survival (OS) for advanced stage (IIIA-IV) non-small cell lung cancer (NSCLC) is highly variable, and retrospective data show a survival advantage for patients receiving therapeutic intent pulmonary resection. We hypothesized that this variability in OS can be modeled separately by stage to allow a personalized estimate of OS. METHODS: In a cohort of patients with advanced-stage NSCLC from the National Cancer Database, we assessed the accuracy of Surgical Selection Score (SSS) to predict OS using Cox proportional hazards models and determined by stage the effect of surgery on survival among people with similarly high levels of SSS. RESULTS: In total, 300,572 patients were identified; 18,701 (6%) had surgery. The SSS was a strong predictor of OS (C-index, 0.89; 95% confidence interval [CI], 0.89-0.90). We observed significantly greater OS (P < .001) among patients who had surgery. The hazard of death was at least 2 times greater for patients in the upper quartile of SSS who did not receive surgery compared with surgical patients even when adjusting for the SSS (stage IIIA: hazard ratio [HR], 2.1; 95% CI, 2.0-2.2, stage IIIB: HR, 2.3; 95% CI, 2.2-2.5, stage IV: HR, 2.3; 95% CI, 2.2-2.4). CONCLUSIONS: The SSS is highly predictive of individual OS and can be used as a risk assessment tool. These findings are important for a more robust evaluation of the likely benefits of surgical resection for these patients. After further prospective validation, the SSS can be used during treatment decision-making for patients with advanced-stage NSCLC.

A Model to Predict the Use of Surgical Resection for Advanced-Stage Non-Small Cell Lung Cancer Patients.

BACKGROUND: For advanced-stage non-small cell lung cancer, chemotherapy and chemoradiotherapy are the primary treatments. Although surgical intervention in these patients is associated with improved survival, the effect of selection bias is poorly defined. Our objective was to characterize selection bias and identify potential surgical candidates by constructing a Surgical Selection Score (SSS). METHODS: Patients with clinical stage IIIA, IIIB, or IV non-small cell lung cancer were identified in the National Cancer Data Base from 1998 to 2012. Logistic regression was used to develop the SSS based on clinical characteristics. Estimated area under the receiver operating characteristic curve was used to assess discrimination performance of the SSS. Kaplan-Meier analysis was used to compare patients with similar SSSs. RESULTS: We identified 300,572 patients with stage IIIA, IIIB, or IV non-small cell lung cancer without missing data; 6% (18,701) underwent surgical intervention. The surgical cohort was 57% stage IIIA (n = 10,650), 19% stage IIIB (n = 3,483), and 24% stage IV (n = 4,568). The areas under the receiver operating characteristic curve from the best-fit logistic regression model in the training and validation sets were not significantly different, at 0.83 (95% confidence interval, 0.82 to 0.83) and 0.83 (95% confidence interval, 0.82 to 0.83). The range of SSS is 43 to 1,141. As expected, SSS was a good predictor of survival. Within each quartile of SSS, patients in the surgical group had significantly longer survival than nonsurgical patients (p < 0.001). CONCLUSIONS: A prediction model for selection of patients for surgical intervention was created. Once validated and prospectively tested, this model may be used to identify patients who may benefit from surgical intervention.

Impact of a student-led community education program to promote Pap test screening among Asian-American women.

INTRODUCTION: Among ethnic groups, Asian-American women have the highest incidence of cervical cancer, low cervical cancer screening rates, and are more likely to state they have "never thought about" and/or "do not need" Pap testing. Through a Patient Advocacy grant awarded by the American Society of Cytopathology Foundation, we developed a culturally sensitive educational outreach program to encourage Pap screening among Asian-Americans in our community. MATERIALS AND METHODS: Educational materials, translated into three languages, were shared at nine community events by undergraduate and medical student volunteers. Pre- and post-education surveys on awareness, knowledge, and attitudes towards screening were administered. Results were tallied and reported as raw percentages. RESULTS: A total of 328 surveys were completed; 80% were Asian respondents. Twenty percent of respondents were not up to date (NUTD) with Pap screening. Knowledge of Pap tests reported as "excellent"/"good" rose from 46% before to 85% after education. Those reporting "very likely"/"likely" to schedule a Pap test increased from 72% to 92% in the NUTD group and from 84% to 97% in the 21-29 age group. Those reporting "very likely"/"likely" to recommend a Pap test to others increased from 68% to 98% in the NUTD group and 77% to 97% in those aged 21-29. CONCLUSIONS: A student-led community-based culturally sensitive outreach approach improved Pap test knowledge and awareness among Asian-Americans. The largest increase in likelihood to obtain a Pap test and recommend the test to others was the NUTD and 21-29 age groups, suggesting influence on those in need of screening.