HEALTH SERVICES RESEARCH AND QUALITY IMPROVEMENT

e18723 Publication Only

Lung cancer treatment patterns in patients with diabetes.

Christian Stephens, Amanda Leiter, Keith Magnus Sigel, Chung Yin Kong, Juan Wisnivesky; Icahn
School of Medicine at Mount Sinai, New York, NY; Department of Endocrinology, Icahn School of Med-
icine at Mount Sinai, New York, NY

Background: Lung cancer is the leading cause of cancer death in the United States, with > 85% classi-
fied as non-small cell lung cancer (NSCLC). Diabetes mellitus (DM) is a common comorbidity in pa-
tients with NSCLC. While surgery is the standard of care for early-stage NSCLC, patients who have DM
with end organ damage are considered medically inoperable according to treatment guidelines and
whether this influences NSCLC treatment and outcomes is unclear. This study aimed to investigate
treatment patterns and outcomes among patients with early-stage NSCLC and DM. Methods: Using the
Surveillance, Epidemiology, and End Results database linked to Medicare (2000-2016), we identified
patients ≥65 years old with Stage I-IIIA NSCLC treated with lobectomy, limited resection (wedge re-
section and segmentectomy), or no surgery. DM and complications at the time of NSCLC diagnosis
were ascertained through published claims-based algorithms. Patients were categorized as having no
DM, DM without severe complications (DM-c), or DM with ≥1 severe complication (i.e., end-organ dam-
age, DM+c). We used multinomial logistic regression to assess if DM was associated with treatment. As-
sociation of DM with overall survival (OS) and lung cancer-specific survival (LCSS) was analyzed with
Cox regression stratified by treatment type. These analyses controlled for demographics, comorbidities,
and NSCLC histology and stage. Results: Of 60,300 patients analyzed, 45,270 (75%) had no DM,
6,873 (12%) had DM-c and 7,887 (13%) had DM+c. More patients with DM+c (N = 4,508[57%]), did
not receive surgery vs. patients with DM-c (N = 3,771[55%]) and without DM (N = 23,289[51%]). DM
was associated with lower odds of receiving lobectomy vs. no surgery in adjusted analysis (odds ratio
[OR]: 0.88; 95% confidence interval [CI]: 0.83-0.93 for DM-c, and OR: 0.91; 95% CI: 0.86-0.97 for
DM+c vs. no DM), but not for limited resection vs. no surgery (OR: 0.92; 95% CI: 0.83-1.02 for DM-c
and OR: 0.91; 95% CI: 0.92-1.11 for DM+c vs. no DM). Cox regression showed that in patients with lo-
bectomy and limited resection, compared to no DM, DM+c was associated with worse OS (hazard ratio
[HR]: 1.21; 95% CI: 1.15 to 1.27 [lobectomy]; HR: 1.17; 95% CI: 1.07-1.28 [limited resection]),
but not LCSS (HR: 1.06; 95% CI: 0.99-1.14 [lobectomy]; HR: 1.02; 95% CI: 0.90-1.17 [limited re-
section]). Among patients who received no surgery, DM+c patients had both worse LCSS (HR: 1.05;
95% CI: 1.00-1.09 and OS (HR: 1.12; 95% CI: 1.08-1.16) vs. no DM. DM-c was not associated with
worse LCSS or OS for all treatment categories. Conclusions: Patients with Stage I-IIIA NSCLC and
DM+c were less likely to undergo surgery and had worse OS but not LCSS if they underwent full or limit-
ed resection, while they had worse OS and LCSS if they did not have surgery. These findings suggest
that patients with DM with end-organ damage benefit from more aggressive NSCLC treatment, but re-
search is needed to determine optimal treatments in these patients. Research Sponsor: None.

© 2022 by American Society of Clinical Oncology. Visit abstracts.asco.org and search by abstract for disclosure information.
Downloaded from ascopubs.org by 180.253.185.106 on December 14, 2023 from 180.253.185.106
Copyright © 2023 American Society of Clinical Oncology. All rights reserved.