Impact Of Age And Comorbidity On Treatment Of Non-Small Cell Lung Cancer (Nsclc) Recurrence (Aft-03).

10037 Background: Older adults with NSCLC with no comorbidities are at risk of under treatment after initial diagnosis while those with severe comorbidities are at risk of over treatment. However, national data on how age and comorbidity impact treatment of recurrent NSCLC are limited. Methods: Through a special study mechanism of the National Cancer Database, we randomly selected 9668 patients with surgically resected stage I-III NSCLC in 2006-07 from 1147 cancer facilities. Registrars reabstracted detailed preoperative comorbidity, recurrence, and treatment information to supplement existing data. Patients were stratified by recurrence status and predictors of active treatment vs supportive care only were analyzed using multiple logistic regression. Results: Median age at diagnosis was 67 (IQR 60-74). The most common comorbidities were COPD (40%) and CAD (21%). After 5-year median follow up, 62% had no recurrence, 11% had locoregional, and 27% had distant recurrence. Among those with locoregional recurrence, 79% received treatment (28% chemo, 25% chemo/radiation, 16% radiation, 10% surgery); 21% received supportive care only. Older patients (adjusted OR 0.73 per decade, p = .0008) and those with substance abuse (aOR 0.41, p = .008) were less likely to receive treatment. Women and patients with symptomatic or ipsilateral lung recurrence (vs lymph node) were also less likely to receive treatment (all p < .02). Among those with distant recurrence, 77% received treatment (30% radiation, 23% chemo, 13% chemo/radiation, 11% surgery); 23% received supportive care only. Older patients were less likely to receive treatment (aOR 0.75, p = .0001) while those without any comorbidities were more likely to receive treatment (aOR 1.65, p = .018). Metastatic site also predicted treatment: contralateral lung or liver metastases decreased the odds of treatment while brain or bone metastases increased the odds (all p < .05). Conclusions: Older patients, independent of comorbidity, were less likely to receive treatment for both locoregional and distant NSCLC recurrence. In contrast, the impact of comorbidity was stronger for distant recurrence, highlighting the importance of avoiding over treatment in the palliative setting.