Grant Number:	1R01CA125447-01A1 Interpret this number
Primary Investigator:	Wisnivesky, Juan
Organization:	Icahn School Of Medicine At Mount Sinai
Project Title:	Evaluating the Effectiveness of Lung Cancer Treatment in the Elderly
Fiscal Year:	2007

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 treatment of these patients. The goal of this proposal is to use national, population-based data to assess the effectiveness of several key therapies for elderly patients with stage I, II, and IMA non-small cell lung cancer (NSCLC). The specific aims are to: 1) determine whether survival after limited resection (wedge resection or segmentectomy) is equivalent to that after lobectomy in patients with small (5 2cm) stage I NSCLC, 2) assess the real world effectiveness of adjuvant chemotherapy in elderly patients with resected stage I to IMA NSCLC, 3) evaluate the effectiveness of RT alone for the treatment of unresected stage I and II NSCLC, and 4) assess the effectiveness of chemotherapy for the primary treatment of elderly patients with unresected stage I and II NSCLC. 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 with histologically confirmed stage I, II, and IMA 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 will be ascertained from both SEER and Medicare. Linked data from the Area Resource File will be used to obtain information on community level factors such as physician availability. The primary outcome will be overall survival and the secondary outcome will be lung cancer-specific survival, as assessed by Medicare and SEER data, respectively. Each Specific Aim will be evaluated by comparing unadjusted survival rates of patients who received and did not receive the therapy under study, by conducting stratified analyses within relevant subgroups, and by using multivariate analyses to control for 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 lung cancer treatment strategies.




Outcomes after Stereotactic Body Radiotherapy versus Limited Resection in Older Patients with Early-Stage Lung Cancer.
Authors: Ezer N. , Veluswamy R.R. , Mhango G. , Rosenzweig K.E. , Powell C.A. , Wisnivesky J.P. .
Source: Journal Of Thoracic Oncology : Official Publication Of The International Association For The Study Of Lung Cancer, 2015 Aug; 10(8), p. 1201-6.
PMID: 26200275
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Comparative outcomes of elderly stage I lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection.
Authors: Smith C.B. , Kale M. , Mhango G. , Neugut A.I. , Hershman D.L. , Mandeli J.P. , Wisnivesky J.P. .
Source: Journal Of Thoracic Oncology : Official Publication Of The International Association For The Study Of Lung Cancer, 2014 Mar; 9(3), p. 383-9.
PMID: 24495998
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Adjuvant treatment for elderly patients with early-stage lung cancer treated with limited resection.
Authors: Veluswamy R.R. , Mhango G. , Bonomi M. , Neugut A.I. , Hershman D.L. , Aldridge M.D. , Wisnivesky J.P. .
Source: Annals Of The American Thoracic Society, 2013 Dec; 10(6), p. 622-8.
PMID: 24024700
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Radiotherapy and chemotherapy for elderly patients with stage I-II unresected lung cancer.
Authors: Wisnivesky J.P. , Bonomi M. , Lurslurchachai L. , Mhango G. , Halm E.A. .
Source: The European Respiratory Journal, 2012 Oct; 40(4), p. 957-64.
PMID: 22241748
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Extent of lymph node resection does not increase perioperative morbidity and mortality after surgery for stage I lung cancer in the elderly.
Authors: Shapiro M. , Mhango G. , Kates M. , Weiser T.S. , Chin C. , Swanson S.J. , Wisnivesky J.P. .
Source: European Journal Of Surgical Oncology : The Journal Of The European Society Of Surgical Oncology And The British Association Of Surgical Oncology, 2012 Jun; 38(6), p. 516-22.
PMID: 22244908
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Effect of radiotherapy planning complexity on survival of elderly patients with unresected localized lung cancer.
Authors: Park C.H. , Bonomi M. , Cesaretti J. , Neugut A.I. , Wisnivesky J.P. .
Source: International Journal Of Radiation Oncology, Biology, Physics, 2011-11-01 00:00:00.0; 81(3), p. 706-11.
EPub date: 2011-11-01 00:00:00.0.
PMID: 20932683
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Limited resection for the treatment of patients with stage IA lung cancer.
Authors: Wisnivesky J.P. , Henschke C.I. , Swanson S. , Yankelevitz D.F. , Zulueta J. , Marcus S. , Halm E.A. .
Source: Annals Of Surgery, 2010 Mar; 251(3), p. 550-4.
PMID: 20160639
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Effectiveness of radiation therapy for elderly patients with unresected stage I and II non-small cell lung cancer.
Authors: Wisnivesky J.P. , Halm E. , Bonomi M. , Powell C. , Bagiella E. .
Source: American Journal Of Respiratory And Critical Care Medicine, 2010-02-01 00:00:00.0; 181(3), p. 264-9.
EPub date: 2010-02-01 00:00:00.0.
PMID: 19892859
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Radiotherapy Planning Complexity and Survival after Treatment of Advanced Stage Lung Cancer in the Elderly.
Authors: Goldsmith B. , Cesaretti J. , Wisnivesky J.P. .
Source: Cancer, 2009-10-15 00:00:00.0; 115(20), p. 4865-4873.
PMID: 21423827
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