A real-world analysis of 30-day post systemic anti-cancer therapy mortality in patients with small cell lung cancer
Carter, Louise Church, Matt
Carter, Louise
Church, Matt
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Abstract
Introduction: Small cell lung cancer (SCLC) is highly aggressive
with a poor prognosis. Chemo-immunotherapy is recommended
as first-line treatment in patients of good performance status and
has excellent response rates. However, patients frequently present
late or with oncological emergencies such as superior vena cava
obstruction (SVCO) where benefits of systemic anti-cancer therapy
(SACT) are less clear. This study aimed to evaluate SCLC patients who
died within 30 days of SACT administration to better understand
this at-risk patient group.
Methods: Patients with SCLC who died within 30 days of receiving
SACT between August 2012 and September 2019 at the Christie
Hospital, UK, were characterised for demographics, oncological
history, clinical features and cause of death. A comparator cohort
of patients who did not die within 30 days was randomly generated
from health records and analysed for statistical differences and
multivariate post-SACT survival.
Results: There were 105 SCLC patients who died within 30 days of
SACT. The majority were elderly and 81% were performance status
2 or 3 (Table 1). SVCO was present in 25%, 82% of patients were
receiving first-line SACT, 42% received single-agent carboplatin and
38% died within ten days of SACT. Cause of death was determined to
be progressive disease in 63% and neutropenic sepsis in 9.5%, with
28.6% possibly related to SACT. Comparison with 95 comparator
patients showed significantly higher SVCO (p=0.01) and performance
status (p<0.001) in the 30-day mortality cohort. Higher performance
status, raised leukocytes and low serum sodium were associated
with lower 30-day post-SACT survival on multivariate analysis
(hazard ratio 1.77, 1.08, 0.96 respectively). Conclusions: International guidelines support combination SACT
in SCLC patients of good performance status, but nuances remain
regarding optimal SACT for frailer patients. These results highlight
the high risk of 30-day post-SACT mortality in SCLC, particularly in
those with markers of poor prognosis.
Affiliation
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Carter L, Church M, Blackhall F. A real-world analysis of 30-day post systemic anti-cancer therapy mortality in patients with small cell lung cancer. Lung Cancer . 2021 Jun;156:S65.