Impact of social isolation on the clinical outcomes in advanced NSCLC patients

BackgroundSocially isolated patients have a higher early mortality rate across multiple cancers. However, there have been no reports on how social isolation such as solitary life affects the clinical outcomes in advanced non-small cell lung cancer (NSCLC).MethodsWe conducted a retrospective analysis of patients with advanced NSCLC who received systemic therapy at the National Cancer Center (NCC) between January 2021 and December 2023. This study assessed the association between social isolation, such as living alone, and clinical outcomes, including overall survival (OS) and the incidence of serious adverse events (SAE) during systemic treatment. Additionally, we evaluated the transition rates to palliative care, both at home and in palliative care units (PCU), as well as the proportion of in-hospital deaths at our institution.ResultsDuring the study period, 679 patients initiated systemic treatment for advanced NSCLC. Of these, 119 patients were living alone (alone group) while the remaining 560 were not (non-alone group). The median age was comparable between the alone and non-alone groups (63 vs. 67 years, p=0.20), but the alone group had a higher proportion of females (46.2% vs. 37.5%, p=0.08). Regarding the driver genetic alterations, there was no significant difference between the two groups in the presence of EGFR mutations (36.1% vs. 32.1%, p=0.70) and ALK rearrangement (7.4% vs. 5.3%, p=0.66). Treatment modalities were also comparable between the alone group and non-alone groups for TKI use (44.1% vs. 39.5%, p=0.86). The alone group showed numerically better outcomes in OS and SAE rates than the non-alone group (OS: not reached vs. 50.7 months, p=0.11; and SAE: 10.9% vs. 18.8%, p=0.08). In the alone group, the transition rates to palliative care at home was significantly lower (13.0% vs. 32.0%, p=0.04), and the proportion of in-hospital deaths (NCC or PCU) was higher compared with non-alone group (82.6% vs. 66.7%, p=0.04).ConclusionsSocial isolation such as living alone did not affect the clinical outcomes such as OS and SAE during the systemic treatment in advanced NSCLC patients. However, it did influence the palliative care practices, resulting in a higher rate of hospital deaths.Legal entity responsible for the studyT.Yoshida.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.