Who are the vulnerable lung cancer patients at risk for not receiving first-line curative or palliative treatment?

Figures & data

Table 1. First-line treatment of non-small cell lung cancer according to clinical TNM stage and performance status.

TNM stage	Stage	Performance status	First-line treatment
T1-2N0M0	I-IIA	0–2	Surgery / Stereotactic radiation / radiotherapy + chemotherapy / Ablation
T3-4N0M0	IIB-IIIA	0–1	Surgery / Chemotherapy / Immunotherapy / Radiotherapy + chemotherapy
T3-4N0M0	IIB-IIIA	2	Surgery / Chemotherapy / Radiotherapy + chemotherapy
T0-3N1M0	IA-IIIA	0–1	Surgery + Chemotherapy / Immunotherapy / Radiotherapy + chemotherapy
T0-3N1M0	IA-IIIA	2	Radiotherapy + chemotherapy / Chemotherapy
T0-3N2-3M0	IIIA-IIIC	0–2^a	Radiotherapy + chemotherapy / Chemotherapy / Immunotherapy
T4N1-3M0	IIIA-IIIC	0–2^a	Chemotherapy / Radiotherapy + chemotherapy / Immunotherapy
TxMxM1	IVA-IVB	0–2^a	Chemotherapy / Radiotherapy + chemotherapy / Immunotherapy / surgery

^aExcept no immunotherapy is given to patients with performance status 2.

The choice of treatment regimen depends on the individual patient’s performance score, comorbidities, and mutation status. If diagnosed with oncogene addicted non-small cell lung cancer, patients are treated with targeted therapy.

Table 2. Characteristics and number of vulnerability factors among 14,597 patients diagnosed with non-small cell lung cancer during 2013–2018 according to stage.

Vulnerability factors	Low-stage (I–IIIA)		High-stage (IIIB–IVB)
	Number	%	Number	%
Total number of patients	6555	100	8042	100
Age at diagnosis
<60	770	12	1150	14
60–69	2240	34	3025	38
70–79	2607	40	2832	35
>80	938	14	1035	13
Gender
Women	3323	51	3957	49
Men	3232	49	4085	51
Year of diagnosis
2013–2015	3676	56	4777	59
2016–2018	2879	44	3265	41
Education
Low	3944	60	4889	62
Medium	1969	31	2418	31
High	496	8	558	7
Living alone
Yes	2770	42	3330	41
No	3777	58	4706	59
Long distance to hospital
Yes	1059	16	904	11
No	5496	84	7138	89
Charlson comorbidity index
Yes	354	59	4085	48
No	2701	49	4356	52
Mental comorbidity
Yes	138	2	168	2
No	6417	98	7874	98
Performance status
0	3602	55	3309	41
1	2187	33	3129	39
2	766	12	1604	20
Alcohol consumption
High	130	2	113	1
Low	6425	98	7929	99
Number of vulnerability factors
No vulnerability factors	943	14	0	0
1 vulnerability factor	2461	38	1118	14
2 vulnerability factors	2047	31	2847	35
3 vulnerability factors	861	13	2610	32
4 vulnerability factors	214	3	1147	14
5 vulnerability factors	28	0.4	281	3
Co-occurring vulnerability factors
At least 1 vulnerability factor	5612	86	8042	100
At least 2 vulnerability factors	3151	48	6924	86
At least 3 vulnerability factors	1104	17	4077	51
At least 4 vulnerability factors	243	4	1467	18
At least 5 vulnerability factors	29	0.4	320	4

Table 3. Odds ratio for receiving treatment among low-stage and among high-stage non-small cell lung cancer patients according to vulnerability factors.

Vulnerability factors	Low-stage (I-IIIA)								High-stage (IIIB-IVB)
	Did not receive curative treatment		Received curative treatment		Unadjusted		Adjusted^a		Did not receive treatment		Received treatment		Unadjusted		Adjusted*
	N	%	N	%	OR	95 % CI	OR	95 % CI	N	%	N	%	OR	95 % CI	OR	95 % CI
Stage
I	483	13	3202	87	1	(reference)	1	(reference)
II	322	22	1150	78	0.54	(0.46–0.63)	0.53	(0.45–0.62)
IIIA	548	39	850	61	0.49	(0.45–0.52)	0.45	(0.42–0.49)
IIIB									96	8	1091	92	1	(reference)	1	(reference)
IIIC									55	11	451	89	0.72	(0.51–1.02)	0.75	(0.52–1.08)
IVA									251	16	1351	84	0.47	(0.37–0.61)	0.50	(0.38–0.64)
IVB									739	16	4008	84	0.80	(0.75–0.85)	0.79	(0.74–1.01)
CCI
No	440	16	2261	84	1	(reference)	1	(reference)	730	18	3355	82	1	(reference)	1	(reference)
Yes	913	24	2941	76	0.63	(0.55–0.71)	0.72	(0.63–0.83)	488	11	3868	89	0.58	(0.51–0.66)	0.77	(0.67–0.88)
Mental comorbidity
No	1322	21	5095	79	1	(reference)	1	(reference)	27	16	141	84	1	(reference)	1	(reference)
Yes	31	22	107	78	0.90	(0.60–1.34)	0.69	(0.45–1.08)	1114	14	6760	86	0.86	(0.57–1.31)	0.72	(0.46–1.12)
Age
<80	988	18	4629	82	1	(reference)	1	(reference)	822	12	6185	88	1	(reference)	1	(reference)
>80	365	39	573	61	0.34	(0.29–0.39)	0.59	(0.55–0.64)	319	31	716	69	0.29	(0.26–0.35)	0.59	(0.54–0.64)
Performance status
<2	1012	17	4777	83	1	(reference)	1	(reference)	685	11	5753	89	1	(reference)	1	(reference)
=2	341	45	425	55	0.26	(0.23–0.31)	0.33	(0.28–0.39)	456	28	1148	72	0.30	(0.26–0.34)	0.38	(0.33–0.44)
Living alone
No	690	18	3087	82	1	(reference)	1	(reference)	544	12	4162	88	1	(reference)	1	(reference)
Yes	662	24	2108	76	0.71	(0.63–0.80)	0.79	(0.69–0.90)	596	18	2734	82	0.60	(0.53–0.68)	0.67	(0.58–0.77)
Long distance to hospital
No	1112	20	4384	80	1	(reference)	1	(reference)	978	14	6160	86	1	(reference)	1	(reference)
Yes	241	23	818	77	0.86	(0.74–1.01)	0.90	(0.76–1.07)	163	18	741	82	0.72	(0.60–0.87)	0.71	(0.58–0.86)
Alcohol consumption
Low	1322	21	5103	79	1	(reference)	1	(reference)	17	15	96	85	1	(reference)	1	(reference)
High	31	24	99	76	0.83	(0.55–1.24)	0.79	(0.51–1.24)	1124	14	6805	86	0.93	(0.55–1.57)	0.91	(0.53–1.57)
Education
High	527	21	1938	79	1	(reference)	1	(reference)	442	15	2534	85	1	(reference)	1	(reference)
Low	826	20	3264	80	1.07	(0.95–1.22)	0.89	(0.78–1.03)	699	14	4367	86	1.09	(0.95–1.24)	0.89	(0.78–1.02)

Abbreviations: N: number; OR: odds ratio; CI: confidence interval; CCI: Charlson comorbidity index.

^aMutually adjusted for all variables in the table.

Table 4. Odds ratio for receiving treatment according to number of vulnerability factors for patients diagnosed with low- and high-stage non-small cell lung cancer.

Vulnerability factors	Low-stage lung cancer patients (I-IIIA)					High-stage non-small cell lung cancer patients (IIIB-IVB)
	Did not receive curative treatment	Received curative treatment	OR (95 % CI)	AIC^a	AUC^b	Did not receive treatment	Received treatment	OR (95 % CI)	AIC^a	AUC^b
At least 2 factors
No	129 (14%)	814 (86%)	1 (reference)			94 (8%)	1024 (92%)	1 (reference)
Yes	1224 (22%)	4388 (78%)	0.57 (0.46–0.69)	6643.680	0.5306	1047 (15%)	5877 (85%)	0.51 (0.41–0.64)	6532.091	0.5330
At least 3 factors
No	538 (16%)	2866 (84%)	1 (reference)			347 (9%)	3618 (91%)	1 (reference)
Yes	815 (26%)	2336 (74%)	0.54 (0.48–0.61)	6577.618	0.5767	794 (19%)	3283 (81%)	0.40 (0.35–0.45)	6377.486	0.6101
At least 4 factors
No	968 (18%)	4483 (82%)	1 (reference)			753 (11%)	5822 (89%)	1 (reference)
Yes	3985 (35%)	719 (65%)	0.40 (0.35–0.47)	6530.765	0.5732	388 (26%)	1079 (74%)	0.36 (0.31–0.41)	6378.678	0.5918
At least 5 factors
No	1241 (20%)	5071 (80%)	1 (reference)			1025 (13%)	6697 (87%)	1 (reference)
Yes	112 (46%)	131 (54%)	0.29 (0.22–0.37)	6596.674	0.5288	116 (36%)	204 (64%)	0.27 (0.21–0.34)	6470.320	0.5361

Abbreviations: OR: odds ratio; CI: confidence interval.

^aThe Akaike information criterion (AIC) is a mathematical method for evaluating how well a model fits the data it was generated from. The smaller the AIC value, the better the model fit.

^bArea Under the Curve (AUC) areal under Receiver Operating Characteristics (ROC) curve.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.