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Grant Details

Grant Number: 5R01CA131348-03 Interpret this number
Primary Investigator: Wisnivesky, Juan
Organization: Icahn School Of Medicine At Mount Sinai
Project Title: Prognosis and Effectiveness of Advanced Lung Cancer Treatment in the Elderly
Fiscal Year: 2010
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Abstract

DESCRIPTION (provided by applicant): Lung cancer is predominantly a disease of older adults. Elderly patients however, are less aggressively treated and under-represented in clinical trials. As a consequence, there are several areas of controversy regarding the staging and treatment of these patients. The goal of this proposal is to use national, population-based data to evaluate several issues related to the staging and treatment of elderly patients with advanced non-small cell lung cancer (NSCLC). The specific aims of the study are to: 1) evaluate the relationship between the number of positive lymph nodes and survival of NSCLC patients with N1 disease after adjustment for other prognostic factors; 2) assess the effectiveness of postoperative radiotherapy (RT) in elderly patients with completely resected stage III NSCLC with N2 disease; 3) determine the role of adjuvant chemotherapy in elderly patients with resected stage III (T4, N0-1) NSCLC; 4) evaluate the effectiveness of RT alone for the primary treatment of elderly stage III patients who are not candidates for combined chemoradiation; and 5) assess the prevalence and identify predictors of severe toxicity requiring hospitalization due to chemotherapy and RT in older patients with advanced stage NSCLC treated in the community. To address these Aims, we will use data from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims. The study cohort will be comprised of all patients >65 years of age with histologically confirmed advanced stage NSCLC diagnosed between 1991 and 2002. Sociodemographic data and information on the extent of disease at diagnosis will be obtained from SEER. Data on the initial course of treatment (surgery, chemotherapy, and RT) will be ascertained from both SEER and Medicare claims. Linked census data and information from the Area Resource File will be used to obtain information on socioeconomic status and community level factors such as physician availability. Additional information about the treating physicians' characteristics will be obtained from the American Medical Association's Physician Masterfile. The primary outcome of Aims 1 to 4 will be overall survival and the secondary outcome will be lung cancer-specific survival, as assessed by Medicare and SEER data, respectively. The outcome of Aim 5, treatment toxicity, will be ascertained from Medicare claims. Each Aim will be evaluated using unadjusted, stratified, and multivariate analyses to control for other important prognostic factors such as socioeconomic characteristics, physician availability, tumor histology, stage, and comorbidities. Additionally, we will use propensity score methods, sensitivity analysis, and instrumental variable techniques to minimize bias inherent to observational studies. The findings from this project will provide information that can directly impact the care of elderly patients with NSCLC and inform the design of future trials of treatment strategies for advanced lung cancer. PUBLIC HEALTH RELEVANCE: Lung cancer is the most common cause of cancer-related mortality among older adults in the United States. Despite the high incidence of lung cancer and high mortality rates, elderly patients are less likely to be vigorously staged, less aggressively treated, and typically under-represented in clinical trials. This study will provide information regarding the efficacy of several therapies and may help resolve several controversies regarding the staging and treatment of elderly patients with advanced stage lung cancer.

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Publications

Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer.
Authors: Sigel K, Lurslurchachai L, Bonomi M, Mhango G, Bergamo C, Kale M, Halm E, Wisnivesky J
Source: Lung Cancer, 2013 Nov;82(2), p. 266-70.
EPub date: 2013 Sep 5.
PMID: 24011407
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Evaluating beliefs associated with late-stage lung cancer presentation in minorities.
Authors: Bergamo C, Lin JJ, Smith C, Lurslurchachai L, Halm EA, Powell CA, Berman A, Schicchi JS, Keller SM, Leventhal H, Wisnivesky JP
Source: J Thorac Oncol, 2013 Jan;8(1), p. 12-8.
PMID: 23207921
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Survival after segmentectomy and wedge resection in stage I non-small-cell lung cancer.
Authors: Smith CB, Swanson SJ, Mhango G, Wisnivesky JP
Source: J Thorac Oncol, 2013 Jan;8(1), p. 73-8.
PMID: 23164939
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Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease.
Authors: Sigel K, Mhango G, Cohen J, Halm EA, Mandeli J, Strauss G, Wisnivesky J
Source: Ann Surg Oncol, 2013 Mar;20(3), p. 1013-9.
EPub date: 2012 Nov 1.
PMID: 23115004
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Postoperative radiotherapy for elderly patients with stage III lung cancer.
Authors: Wisnivesky JP, Halm EA, Bonomi M, Smith C, Mhango G, Bagiella E
Source: Cancer, 2012 Sep 15;118(18), p. 4478-85.
EPub date: 2012 Feb 13.
PMID: 22331818
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Radiotherapy and chemotherapy for elderly patients with stage I-II unresected lung cancer.
Authors: Wisnivesky JP, Bonomi M, Lurslurchachai L, Mhango G, Halm EA
Source: Eur Respir J, 2012 Oct;40(4), p. 957-64.
EPub date: 2012 Jan 12.
PMID: 22241748
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Lung cancer physicians' referral practices for palliative care consultation.
Authors: Smith CB, Nelson JE, Berman AR, Powell CA, Fleischman J, Salazar-Schicchi J, Wisnivesky JP
Source: Ann Oncol, 2012 Feb;23(2), p. 382-7.
EPub date: 2011 Jul 29.
PMID: 21804051
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Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer: observational cohort study.
Authors: Wisnivesky JP, Smith CB, Packer S, Strauss GM, Lurslurchachai L, Federman A, Halm EA
Source: BMJ, 2011 Jul 14;343, p. d4013.
EPub date: 2011 Jul 14.
PMID: 21757436
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Validation of the lymph node ratio as a prognostic factor in patients with N1 nonsmall cell lung cancer.
Authors: Jonnalagadda S, Arcinega J, Smith C, Wisnivesky JP
Source: Cancer, 2011 Oct 15;117(20), p. 4724-31.
EPub date: 2011 Mar 30.
PMID: 21452193
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The number of lymph node metastases as a prognostic factor in patients with N1 non-small cell lung cancer.
Authors: Jonnalagadda S, Smith C, Mhango G, Wisnivesky JP
Source: Chest, 2011 Aug;140(2), p. 433-40.
EPub date: 2011 Feb 3.
PMID: 21292754
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Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer.
Authors: Wisnivesky JP, Arciniega J, Mhango G, Mandeli J, Halm EA
Source: Thorax, 2011 Apr;66(4), p. 287-93.
EPub date: 2010 Dec 2.
PMID: 21131298
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Disparities in lung cancer stage, treatment and survival among American Indians and Alaskan Natives.
Authors: Smith CB, Bonomi M, Packer S, Wisnivesky JP
Source: Lung Cancer, 2011 May;72(2), p. 160-4.
PMID: 20889227
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