Do patients with small cell lung cancer (SCLC) who have chemotherapy initiated during a hospital admission benefit from therapy?
Bibliographic record
Abstract
e17661 Background: Lung cancer patients (pts) admitted to hospital in Canada generally have a poor performance status (ECOG 3 or 4). This often precludes treatment for pts with NSCLC, although many oncologists will offer chemotherapy (CT) to hospitalized SCLC pts due to rapid and frequent responses. However, this practice is based on little published data. This study investigates the proportion of SCLC pts with CT initiated in hospital and their outcomes. Methods: We conducted a retrospective cohort study of all Ontario pts diagnosed with SCLC (ICD-9 codes 162.2-162.9) between January 1, 2000-December 31, 2010. De-identified data including demographic, staging, treatment and outcome information were extracted by the Institute for Clinical Evaluative Sciences. The outcomes of this sub-study were the proportion of patients initiating CT while hospitalized versus outpatient based CT initiation and their overall survival. Initiation of CT while admitted to hospital was defined as the first instance of billing for CT dated between a hospital admission and discharge. Results: Among 9021 pts diagnosed with SCLC, 6,568 (73.8%) received chemotherapy, of which 1631 (24.8%) initiated CT while admitted to hospital. The proportion of pts treated in hospital decreased over time. More pts initiating CT in hospital had late stage disease at diagnosis compared to those treated as outpatients, although staging information was not routinely recorded prior to 2007. Median overall survival (OS) for SCLC pts initiating CT in hospital was 6.9 months versus 11.7 months for those treated as outpatients and 1.4 months for patients receiving no CT. One year survival rates were 24.8%, 48.7%, and 10.4%, respectively. All differences have a p-value <0.001. Conclusions: This study shows that a substantial proportion of pts initiate CT while admitted to hospital. These pts likely have a poor performance status. While treatment of this group is associated with poorer median OS than patients initiating CT as an outpatient, CT appears to prolong life in comparison to no treatment. These data provide supportive evidence for the use of CT in poor functioning pts with SCLC.
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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 | 0.001 |
| 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 | 0.001 |
| 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".