NEW YORK – While veterans with locoregional non-small cell lung cancer (NSCLC) might find adjuvant chemotherapy beneficial, the risks might outweigh the benefit for some of them.
A new study in Current Problems in Cancer suggested, however, that the value proposition is affected by comorbidities and other factors.1
Researchers from the Icahn School of Medicine at Mount Sinai in New York and the James J. Peters VAMC in Bronx, NY, identified the optimal indications for adjuvant chemotherapy in veterans with NSCLC, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and/or coronary artery disease (CAD).
To do that, the study team used data from randomized controlled trials (RCTs) and VA databases to create a simulation model. “Then, we conducted in-silico RCTs comparing adjuvant chemotherapy vs observation among veterans with stage II-IIIA NSCLC,” researchers explained.
Results indicated that, for veterans without COPD or CKD, “adjuvant chemotherapy was the optimal strategy regardless of the presence or absence of CAD except for patients >70 years with squamous cell carcinoma. Conversely, most veterans without COPD but with CKD were optimally managed with observation.”
The authors noted that veterans with COPD, but without CKD, received benefit from adjuvant chemotherapy if they were 70 or older with stage II-IIIA adenocarcinoma or younger than 60 years with stage II-IIIA squamous cell carcinoma.
On the other hand, “Adjuvant chemotherapy was only beneficial for veterans with both COPD and CKD among stage II-IIIA adenocarcinoma <60 years of age,” researchers advised. “Veterans with stages II-IIIA squamous cell carcinoma, COPD, and CKD were optimally managed with observation.”
Researchers concluded, “Many veterans with comorbidities are optimally managed with observation post-surgical resection. However, we also identified several groups of veterans for whom the benefits of adjuvant chemotherapy outweighed the risks of early toxicity. Our findings could inform patient-provider discussions and potentially reduce physicians’ uncertainty about the role of adjuvant chemotherapy in this population.”
A study two years ago mentioned a specific comorbidity that could affect the success of adjuvant chemotherapy in veterans. Researchers from the Dana-Farber Cancer Institute in Boston, the University of California, San Francisco Department of Medicine and the San Francisco VAMC.2
Researchers conducted a cohort study of 55,315 U.S.veterans diagnosed with NSCLC, finding that 18,229 had a preexisting mental health disorder. Their study published in JAMA Oncology found that veterans with a preexisting mental health disorder who participated in treatment programs had a likelihood of being diagnosed with advanced cancer, a higher likelihood of receiving stage-appropriate treatment, and lower all-cause and lung cancer-specific mortality.
“The findings of this cohort study indicate that investment in mental health may be associated with improved cancer-related outcomes, but further research is needed to identify, evaluate, and implement effective interventions to improve outcomes for people with preexisting mental health disorders who are diagnosed with cancer,” the authors wrote.
- Bailey S, Wang Q, Kong CY, Stone K, Veluswamy R, Bates SE, Smith CB, Wisnivesky JP, Sigel K. Optimizing the use of adjuvant chemotherapy in non-small cell lung cancer patients with comorbidities. Curr Probl Cancer. 2022 May 21;46(4):100867. doi: 10.1016/j.currproblcancer.2022.100867. Epub ahead of print. PMID: 35687964.
- Berchuck JE, Meyer CS, Zhang N, et al. Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non–Small Cell Lung Cancer. JAMA Oncol. 2020;6(7):1055–1062. doi:10.1001/jamaoncol.2020.1466
