Referral patterns for adjuvant therapy in non-small cell lung cancer
Bibliographic record
Abstract
7217 Background Lung cancer remains a leading cause of cancer-related mortality in North America. Despite potentially curative resection, NSCLC patients remain at high risk of relapse and death, with a five-year survival less than 60%. Several randomized trials now confirm the survival benefit of adjuvant platinum-based chemotherapy seen in the NSCLC Collaborative Group meta-analysis, including the IALT, NCIC BR 10 and CALGB 9633, with absolute improvements in 4 & 5-year survival of 4 to15%. This study examines whether referral patterns for adjuvant therapy have changed with these confirmatory trials. Methods Retrospective chart review undertaken at a single cancer center, identifying patients with completely resected stage I-IIIA NSCLC from May 2003 to Nov 2004 through an institutional Cancer Registry. Patients treated with neoadjuvant therapy excluded. Results 160 patients identified (44 IA, 60 IB, 7 IIA, 35 IIB, 14 IIIA). Institutional policy prior to May 2003 was not to administer adjuvant therapy outside a clinical trial. After presentation of the IALT trial, 31% (36/115) of patients with completely resected NSCLC from May 2003 to May 2004 were referred for adjuvant chemotherapy. After the presentation of BR 10 & CALGB 9633 at ASCO 2004, from June to Nov 2004, 59% (23/39) were referred. Reasons for not referring to medical oncology included: stage IA disease, surgeon felt adjuvant therapy inappropriate, patient declined, comorbidities, post-operative complications, advanced age & other. Of 59 patients referred to medical oncology, 21 (35%) received adjuvant chemotherapy. Reasons for not prescribing adjuvant chemotherapy included: patient wish (18), comorbidities, stage 1A, advanced age & other. Vinorelbine/cisplatin was the regimen most commonly used (76%). Conclusions The presentation of positive adjuvant therapy trials in NSCLC has changed clinical practice substantially, doubling the number of stage I-IIIA NSCLC patients referred for adjuvant chemotherapy since May 2004 (31% vs. 59%). Stage IA patients are not routinely referred and 30% of patients decline chemotherapy even when recommended by a medical oncologist. More patient education and decision support is required to increase uptake of adjuvant therapy in early stage NSCLC. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".