Patterns of care and survival for lung cancer: Results of the European population-based high-resolution study

Abstract

ObjectivesTo investigate differences in lung cancer (LC) management and survival using data from European population cancer registries.MethodsWe analysed 4,602 lung cancer cases diagnosed in 2010–2013, followed-up to 2019 in five countries. Multivariable logistic regression was used to calculate the Odds Ratio (OR) of surgery for stages I–II LC or chemo- or radiotherapy for stages III–IV LC. Relative survival (RS) was estimated by the actuarial method; Relative Excess Risk of death (RER), with 95% CI, was calculated by generalized linear models.ResultsDiagnostic work-up was extensive for 65.9% patients (range 57%, Estonia, Portugal - 85% (Belgium). Sixty-six percent of stages I–II patients underwent surgery; compared to non-operated, their adjusted OR decreased with age and was associated with main bronchus cancer (OR vs. lobes 0.25, CI, 0.08–0.82), stage II (OR vs. stage I: 0.42, CI, 0.29–0.60), comorbidity (OR vs. absent: 0.55, CI, 0.33–0.93), country (ORs: Estonia 1.82, CI, 1.28–2.60; Belgium 0.62, CI, 0.42–0.91; Portugal 0.69, CI, 0.52–0.93).Almost half of stages III–IV patients received chemo- or radiotherapy only; the adjusted OR vs. non receiving decreased with age and was associated with unspecified cancer topography or morphology. The adjusted five-year RER increased with age and stage and was lower for women (0.78, CI, 0.72–0.86), above the reference for main bronchus cancer (1.37, CI, 1.21–1.54) and unspecified morphology (1.17, CI, 1.05–1.30). Surgery carried the lowest mortality (RS 56.9; RER 0.13, CI, 0.11–0.15) with RER above the mean in Estonia (1.20, CI, 1.10–1.30), below it in Portugal (0.88, CI, 0.82–0.93) and Switzerland (0.91, CI, 0.84–0.99). Comorbidity (1.21, CI, 1.09–1.35) and not smoking (0.68, CI, 0.57–0.81) were associated with RER.ConclusionsThe survival benefit of early diagnosis, allowing curative surgery, was evident at the population level. Screening for subjects at risk and adhesion to standard care should be incremented across the EU by funding better equipment and training health personnel.

Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin

“…Elderly (here defined as ≥70 years) represent a high proportion of lung cancer patients in Europe. In a large patterns of care analysis with >4500 patients, Sant et al reported that 46.9% were elderly [4]. At the same time, higher age is associated with relevant physiologic changes in the thoracic organs (e.g., reduced chest wall compliance) and further organ systems (e.g., kidney function) [3,[5][6][7][8].…”

“…Higher age is associated with an increased risk of lung cancer [3]. In a patterns of care study on lung cancer across Europe by Sant et al,46.9% of the patients were ≥70 years old [4].…”