Older NSCLC Patients See Many Doctors, Multiple Medications, in Months After Treatment

Older NSCLC Patients See Many Doctors, Multiple Medications, in Months After Treatment

Older patients with early stage non-small-cell lung cancer (NSCLC) see an average of 20 physicians over multiple visits, and take 12 medications after a typical treatment, researchers found in a study assessing healthcare burdens.

They urged physicians to consider reducing the visits and tests patients undergo to simplify the treatment process.

The findings were detailed in “Treatment Burden of Medicare Beneficiaries With Stage I Non-Small Cell Lung Cancer,” which was published in the Journal of Oncology Practice.

“To our knowledge, this is the first study to characterize treatment burden for early-stage lung cancer patients in terms of touches with the healthcare system, including emergency department visits, hospital-based follow-up care, number of physicians, and outpatient visits,” lead author Carolyn Presley, instructor at Yale Cancer Center and a Robert Wood Johnson Clinical Scholar at Yale School of Medicine, said in a news release.

Treatment burden is particularly important in dealing with cancer, which is associated with intensive therapy regimens and variable prognosis. Understanding patients’ problems may help doctors lessen their burdens and minimize healthcare disruptions.

“We have to start incorporating the patient voice in treatment decisions and really investing in case management and care coordination,” Presley said, indicating that “reducing the number of visits, scheduling them on the same days, and reducing redundant tests, labs, and medications would greatly improve the daily lives of cancer patients.”

Presley and her colleagues conducted a retrospective analysis of 7,955 Medicare beneficiaries who received their NSCLC diagnosis between 2007 and 2011. All were treated with surgery (76.4%), stereotactic body radiation therapy (SBRT; 10.1%), or external beam radiation therapy (EBRT; 13.5%).

An age range for the patients was not provided, but the median age for lung cancer diagnosis is 70.

The researchers counted the number of days the patients were in contact with the healthcare system, the number of physicians involved in their care, and the number of medications they were prescribed.

Patients spent, on average, one in three days in contact with the healthcare system in the first 60 days of treatment, the researchers found. A year after treatment, they had a median of 44 days during which they were in contact with the system. Patients spent a median of nine days in the hospital.

“These findings highlight a need to improve cancer care coordination. It’s also a call for providers to think about the burden we might be placing on patients,” Presley said.

Patients who had surgery had a higher treatment burden than those treated with SBRT. People who received EBRT had the greatest burden.

“We found that after a typical treatment for cancer, older patients saw an average of 20 different physicians during multiple visits and took 12 different medications,” Presley said. “These numbers are very high and a lot to expect of older patients who often have mobility issues or functional limitations. With every additional visit and prescription, there is additional room for errors.”

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