Keith Sigel1, Chung Yin Kong1, Sadiq Rehmani1, Susan Bates2,3, Michael Gould4, Kimberly Stone1, Minal Kale1, Yeun-Hee Park2,3, Kristina Crothers5,6, Faiz Bhora7, Juan Wisnivesky1. 1. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America. 2. James J. Peters VA Medical Center, Bronx, New York, New York, United States of America. 3. Columbia University School of Medicine, New York, New York, United States of America. 4. Kaiser Permanente Southern California, Los Angeles, California, United States of America. 5. University of Washington School of Medicine, Seattle, Washington, United States of America. 6. Puget Sound VA Medical Center, Seattle, Washington, United States of America. 7. Nuvance Health, Danbury, Connecticut, United States of America.
Abstract
BACKGROUND: Veterans are at increased risk of lung cancer and many have comorbidities such as chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). We used simulation modeling to assess projected outcomes associated with different management strategies of Veterans with stage I non-small cell lung cancer (NSCLC) with COPD and/or CAD. PATIENTS AND METHODS: Using data from a cohort of 14,029 Veterans (years 2000-2015) with NSCLC we extended a well-validated mathematical model of lung cancer to represent the management and outcomes of Veterans with stage I NSCLC with COPD, with or without comorbid CAD. We simulated multiple randomized trials to compare treatment with lobectomy, limited resection, or stereotactic body radiation therapy (SBRT). Model output estimated expected quality adjusted life years (QALY) of Veterans with stage I NSCLC according to age, tumor size, histologic subtype, COPD severity and CAD diagnosis. RESULTS: For Veterans <70 years old lobectomy was associated with greater projected quality-adjusted life expectancy regardless of comorbidity status. For most combinations of tumors and comorbidity profiles there was no dominant treatment for Veterans ≥80 years of age, but less invasive treatments were often superior to lobectomy. Dominant treatment choices differed by CAD status for older patients in a third of scenarios, but not for patients <70 years old. CONCLUSIONS: The harm/benefit ratio of treatments for stage I NSCLC among Veterans may vary according to COPD severity and the presence of CAD. This information can be used to direct future research study design for Veterans with stage I lung cancer and COPD and/or CAD.
BACKGROUND: Veterans are at increased risk of lung cancer and many have comorbidities such as chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). We used simulation modeling to assess projected outcomes associated with different management strategies of Veterans with stage I non-small cell lung cancer (NSCLC) with COPD and/or CAD. PATIENTS AND METHODS: Using data from a cohort of 14,029 Veterans (years 2000-2015) with NSCLC we extended a well-validated mathematical model of lung cancer to represent the management and outcomes of Veterans with stage I NSCLC with COPD, with or without comorbid CAD. We simulated multiple randomized trials to compare treatment with lobectomy, limited resection, or stereotactic body radiation therapy (SBRT). Model output estimated expected quality adjusted life years (QALY) of Veterans with stage I NSCLC according to age, tumor size, histologic subtype, COPD severity and CAD diagnosis. RESULTS: For Veterans <70 years old lobectomy was associated with greater projected quality-adjusted life expectancy regardless of comorbidity status. For most combinations of tumors and comorbidity profiles there was no dominant treatment for Veterans ≥80 years of age, but less invasive treatments were often superior to lobectomy. Dominant treatment choices differed by CAD status for older patients in a third of scenarios, but not for patients <70 years old. CONCLUSIONS: The harm/benefit ratio of treatments for stage I NSCLC among Veterans may vary according to COPD severity and the presence of CAD. This information can be used to direct future research study design for Veterans with stage I lung cancer and COPD and/or CAD.
Authors: Lee M Ellis; David S Bernstein; Emile E Voest; Jordan D Berlin; Daniel Sargent; Patricia Cortazar; Elizabeth Garrett-Mayer; Roy S Herbst; Rogerio C Lilenbaum; Camelia Sima; Alan P Venook; Mithat Gonen; Richard L Schilsky; Neal J Meropol; Lowell E Schnipper Journal: J Clin Oncol Date: 2014-03-17 Impact factor: 44.544
Authors: R J Landreneau; D J Sugarbaker; M J Mack; S R Hazelrigg; J D Luketich; L Fetterman; M J Liptay; S Bartley; T M Boley; R J Keenan; P F Ferson; R J Weyant; K S Naunheim Journal: J Thorac Cardiovasc Surg Date: 1997-04 Impact factor: 5.209
Authors: Juan P Wisnivesky; Claudia I Henschke; Scott Swanson; David F Yankelevitz; Javier Zulueta; Sue Marcus; Ethan A Halm Journal: Ann Surg Date: 2010-03 Impact factor: 12.969
Authors: Keith Sigel; Chung Yin Kong; Amanda Leiter; Minal Kale; Grace Mhango; Brian Huang; Michael K Gould; Juan Wisnivesky Journal: Lung Cancer Date: 2022-05-30 Impact factor: 6.081