Long-term dependency in older adults after surgery or stereotactic body radiation therapy for stage I non-small cell lung cancer

Objective — To examine long-term healthcare dependency outcomes of SBRT to surgery for older adults with stage I non-small cell lung cancer (NSCLC).

Summary Background Data — SBRT is an emerging alternative to surgery in patients with early-stage lung cancer. There remains a paucity of prospective studies comparing these modalities, especially with respect to long-term dependency outcomes in older adults with lung cancer.

Methods — Adults ≥70 years old with stage I NSCLC treated with surgery or SBRT from January 2010-December 2017 were analyzed using 1:1 propensity score matching. Homecare use, days at home, and time spent alive and at home, were compared. E-value methods assessed residual confounding.

Results — A total of 1129 and 2570 patients underwent SBRT and surgery, respectively. 1,016 per group were matched. SBRT was associated with a higher overall risk of homecare utilization (HR 1.75, 95%CI 1.37, 2.23) than surgery, up to five years following treatment. While the hazards of death or nursing home admission were lower in the first 3 months after SBRT (HR 0.55, 95%CI 0.36-0.85), they became consistently higher beyond this period, and remained high up to five years compared to surgery (HR 2.13; 95%CI 1.85-2.45). The above findings persisted in stratified analyses for frail patients and those with no pre-treatment homecare. E-values indicated it was unlikely that the observed estimates could be explained by unmeasured confounders.

Conclusions — Surgery offers robust long-term dependency outcomes compared to SBRT. These are important patient-centred endpoints, which may be used for counselling and shared-decision making in older adults with stage I NSCLC.