Access Type

Open Access Dissertation

Date of Award

January 2011

Degree Type


Degree Name




First Advisor

Gail A. Jensen Summers


Evidence-based guidelines recommend chemotherapy for medically fit patients with stage II-IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, this dissertation describes chemotherapy use relative to guideline recommendations and identifies patient factors and outcomes associated with guideline concordant use. Among these patients 29% do not receive guideline recommended chemotherapy treatment, missing opportunities for cure or receiving chemotherapy with more risk of harm than benefit, thereby likely foregoing beneficial palliation. Care concordant with guidelines is influenced by age, and economic considerations, such as income, and transportation barriers. Guideline adherent use of chemotherapy reduced risk of dying. Overuse of chemotherapy also reduced risk of dying. Among poor PS patients, stage IV diagnosis was also associated with survival. Chemotherapy has positive effects on survival for both good and poor PS patients. In the poor PS group, the relationship between chemotherapy and survival is affected by other unobservable factors.