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Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities

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 stag...

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Autores principales: Sigel, Keith, Kong, Chung Yin, Rehmani, Sadiq, Bates, Susan, Gould, Michael, Stone, Kimberly, Kale, Minal, Park, Yeun-Hee, Crothers, Kristina, Bhora, Faiz, Wisnivesky, Juan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971489/
https://www.ncbi.nlm.nih.gov/pubmed/33735217
http://dx.doi.org/10.1371/journal.pone.0248067
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author Sigel, Keith
Kong, Chung Yin
Rehmani, Sadiq
Bates, Susan
Gould, Michael
Stone, Kimberly
Kale, Minal
Park, Yeun-Hee
Crothers, Kristina
Bhora, Faiz
Wisnivesky, Juan
author_facet Sigel, Keith
Kong, Chung Yin
Rehmani, Sadiq
Bates, Susan
Gould, Michael
Stone, Kimberly
Kale, Minal
Park, Yeun-Hee
Crothers, Kristina
Bhora, Faiz
Wisnivesky, Juan
author_sort Sigel, Keith
collection PubMed
description 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.
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spelling pubmed-79714892021-03-31 Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities Sigel, Keith Kong, Chung Yin Rehmani, Sadiq Bates, Susan Gould, Michael Stone, Kimberly Kale, Minal Park, Yeun-Hee Crothers, Kristina Bhora, Faiz Wisnivesky, Juan PLoS One Research Article 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. Public Library of Science 2021-03-18 /pmc/articles/PMC7971489/ /pubmed/33735217 http://dx.doi.org/10.1371/journal.pone.0248067 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Sigel, Keith
Kong, Chung Yin
Rehmani, Sadiq
Bates, Susan
Gould, Michael
Stone, Kimberly
Kale, Minal
Park, Yeun-Hee
Crothers, Kristina
Bhora, Faiz
Wisnivesky, Juan
Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title_full Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title_fullStr Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title_full_unstemmed Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title_short Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
title_sort optimal treatment strategies for stage i non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971489/
https://www.ncbi.nlm.nih.gov/pubmed/33735217
http://dx.doi.org/10.1371/journal.pone.0248067
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