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Damhuis RAM, Senan S, Khakwani A, Harden S, Helland Ȧ, Strand TE. Age-related treatment patterns for stage I NSCLC in three European countries. J Geriatr Oncol 2021; 12:1214-1219. [PMID: 33994330 DOI: 10.1016/j.jgo.2021.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/09/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgery is the preferred treatment for patients with early-stage non-small cell lung cancer (NSCLC) while stereotactic body radiation therapy (SBRT) may be applied in patients with major comorbidity or high age. We evaluated the association between age and treatment utilization for early-stage NSCLC in patients diagnosed in 2015-2016 in three European countries. PATIENTS AND METHODS Information was retrieved from population-based registries in England, Norway and the Netherlands. Treatment patterns and two-year overall survival rates for 105,124 patients with clinical stage I were analysed by age-group. RESULTS Surgical resection rates were higher in Norway (55%) and England (53%) than in the Netherlands (47%), and decreased with increasing age. SBRT use was highest in the Netherlands (41%), followed by Norway (29%) and England (12%). In the Netherlands, SBRT was the prevailing treatment in patients aged 70 years or older. In octogenarians, the proportion not receiving curative intent treatment was 53% in England, versus 35% in Norway and 22% in the Netherlands. Two-year survival rates were better for surgery than for SBRT and slightly better in Norway. CONCLUSION In patients aged 70 years or older, the proportion not receiving any curative treatment remains substantial, and differs significantly between countries. Measures to address these disparities are needed.
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Affiliation(s)
- Ronald A M Damhuis
- Department of Research and Development, Association of Comprehensive Cancer Centres, Utrecht, Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Susan Harden
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ȧslaug Helland
- Department of Oncology, Oslo University Hospital, University of Oslo, Clinical Medicine, Oslo, Norway
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Is the English Cancer Patient Experience Survey representative? A comparative analysis with the National Lung Cancer Audit. Lung Cancer 2019; 140:27-34. [PMID: 31846785 DOI: 10.1016/j.lungcan.2019.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Healthcare systems increasingly recognise the importance of service users' perspectives for improving care organisation and delivery. The English Cancer Patient Experience Survey (CPES) is carried out annually, however, its representativeness within cancer types is unknown. We have explored if the CPES results are representative of people with lung cancer. MATERIALS AND METHODS We linked cancer registry data across multiple sources to assess how CPES represents sociodemographic and clinical characteristics of the National Lung Cancer Audit population, accounting for post-sampling mortality bias. Multivariable logistic regression was used to compare people included and not included in CPES. RESULTS Of 240,375 people diagnosed (2009-2015), 15,967 (7 %) were included in CPES. Gender and ethnicity were reasonably represented, as were sociodemographic and clinical groupings, although more received anti-cancer treatment (96 % of CPES respondents vs. 56 % of patients nationally; adjusted odds ratio = 10.3, 95 % confidence interval 9.4-11.2 for any anti-cancer treatment) with chemotherapy most over-represented, followed by surgery and then radiotherapy. CPES under-represented older, more socioeconomically deprived, and certain clinical groups, including those with worse performance status, multiple comorbidities, and diagnosis via emergency presentation. CONCLUSION CPES includes patients across the sociodemographic and clinical spectrum indicating its value for research and service planning. Unbalanced representation of incident lung cancer cases is a limitation that must be considered in context of using CPES findings to implement service changes. Although half the national lung cancer population who received no anti-cancer treatment do not have their experiences represented, the strength of this dataset is in providing detailed comparisons of patient experiences across different treatment groups.
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Stone E, Rankin NM, Vinod SK, Nagarajah M, Donnelly C, Currow DC, Fong KM, Phillips JL, Shaw T. Clinical impact of data feedback at lung cancer multidisciplinary team meetings: A mixed methods study. Asia Pac J Clin Oncol 2019; 16:45-55. [PMID: 31721458 DOI: 10.1111/ajco.13278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022]
Abstract
AIM Multidisciplinary team (MDT) meetings can facilitate optimal lung cancer care, yet details of structured data collection and feedback remain sparse. This study aimed to investigate data collection and the impact of feedback to lung cancer MDTs. METHODS A mixed-methods study using pre and post-test surveys, semistructured interviews, and observation to evaluate data collection and response to modeled data feedback in three Australian lung cancer MDTs at different locations and development stage (site A: outer metropolitan, established; site B, outer metropolitan, new; and site C, inner metropolitan, established). RESULTS MDT attendees (range 13-25) discussed 5-8 cases per meeting. All sites collected data prospectively (80% prepopulated) into local oncology medical information systems. The pretest survey had 17 respondents in total (88% clinicians). At sites A and C, 100% of respondents noted regular data audits, occasional at site B. Regular audit data included number of cases, stage, final diagnosis, and time to diagnosis and treatment. The post-test survey had 25 respondents in total, all clinicians. The majority (88-96%) of respondents found modeled data easy to interpret, relevant to clinical practice and the MDT, and welcomed future regular data presentations (as rated on a 5-point Likert scale mean weighted average 4.5 where > 4 demonstrates agreement). Semistructured interviews identified five major themes for MDTs: current practice, attitudes, enablers, barriers, and benefits for the MDT. CONCLUSIONS MDT teams exhibited positive responses to modeled data feedback. Key characteristics of MDT data were identified and may assist with future team research and development.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine, St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole M Rankin
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Mohan Nagarajah
- Department of Respiratory and Sleep Medicine, Blacktown Hospital, Western Sydney University, Sydney, New South Wales, Australia
| | - Candice Donnelly
- Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, Charles Perkins Centre, University of Sydney and Sydney West Translational Cancer Research Centre, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Shaw
- Director of Research in Implementation Science and e-Health (RISe), Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Moldaver D, Hurry M, Evans WK, Cheema PK, Sangha R, Burkes R, Melosky B, Tran D, Boehm D, Venkatesh J, Walisser S, Orava E, Grima D. Development, validation and results from the impact of treatment evolution in non-small cell lung cancer (iTEN) model. Lung Cancer 2019; 139:185-194. [PMID: 31812889 DOI: 10.1016/j.lungcan.2019.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Treatment of advanced NSCLC (aNSCLC) is rapidly evolving, as new targeted and immuno-oncology (I-O) treatments become available. The iTEN model was developed to predict the cost and survival benefits of changing aNSCLC treatment patterns from a Canadian healthcare system perspective. This report describes iTEN model development and validation. MATERIALS & METHODS A discrete event patient simulation of aNSCLC was developed. A modified Delphi process using Canadian clinical experts informed the development of treatment sequences that included commonly used, Health Canada approved treatments of aNSCLC. Treatment efficacy and the timing of progression and death were estimated from published Kaplan-Meier progression free and overall survival data. Costs (2018 CDN$) included were: drug acquisition and administration, imaging, monitoring, adverse events, physician visits, best supportive care, and end-of-life. RESULTS AND CONCLUSION Clinical validity of the iTEN model was assessed by comparing model survival predictions to published real-world evidence (RWE). Four RWE studies that reported the overall survival of patients treated with a broad sampling of common aNSCLC treatment patterns were used for validation. The validation coefficient of determination was R2 = 0.95, with the model generally producing estimates that were neither optimistic nor conservative. The model estimated that current Canadian practice patterns yield a median survival of almost 13 months, a five-year survival rate of 3% and a life-time per-treated-patient cost of $110,806. Cost and survival estimates are presented and were found to vary by aNSCLC subtype. In conclusion, the iTEN model is a reliable tool for forecasting the impact on cost and survival of new treatments for aNSCLC.
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Affiliation(s)
| | | | | | | | | | | | | | - Diana Tran
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Jaya Venkatesh
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Susan Walisser
- BC Cancer (Retired), Vancouver, British Columbia, Canada
| | - Erik Orava
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada.
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Phillips I, Sandhu S, Lüchtenborg M, Harden S. Stereotactic Ablative Body Radiotherapy Versus Radical Radiotherapy: Comparing Real-World Outcomes in Stage I Lung Cancer. Clin Oncol (R Coll Radiol) 2019; 31:681-687. [PMID: 31377081 DOI: 10.1016/j.clon.2019.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/05/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022]
Abstract
AIMS Stereotactic ablative body radiotherapy (SABR) is now considered the standard of care for medically inoperable stage I non-small cell lung cancer (NSCLC). The English National Cancer Registration and Analysis Service (NCRAS) collects data on all patients diagnosed with lung cancer, including information on treatment. We wanted to compare outcomes for patients with stage I NSCLC treated with radical radiotherapy with either SABR or fractionated radiotherapy. MATERIALS AND METHODS All patients diagnosed with stage I NSCLC in 2015 and 2016 were identified from the NCRAS dataset, validated by the National Lung Cancer Audit, and their treatment data were collated. For patients who received radiotherapy, those receiving radical dose fractionations, including SABR, were identified through linkage to the national Radiotherapy Dataset. Clinical outcomes for those receiving SABR or more fractionated radical radiotherapy were compared using univariate and fully adjusted Cox proportional hazards models. RESULTS In total, 12 384 patients with stage I NSCLC were identified during the study period; 53.5% underwent surgical resection, 24.3% received no documented treatment, 18.6% received radical radiotherapy and 3.5% received other non-curative-intent treatments. For those receiving radical radiotherapy, 69% received SABR and 31% received fractionated treatment. The hazard ratio of death for the 1587 patients who received SABR was 0.69 (95% confidence interval 0.61-0.79) compared with 717 patients who received radical fractionated radiotherapy; this benefit was seen for both stage Ia and stage Ib disease. The median overall survival was also longer for SABR versus radical radiotherapy (715 days versus 648 days). Exploratory travel time analysis shows that compared with stage I NSCLC patients receiving SABR, those receiving fractionated radiotherapy and those receiving no active treatment would have to travel longer and further to reach their nearest radiotherapy SABR centre. CONCLUSION This study adds to the data that SABR has a survival benefit when compared with fractionated radical radiotherapy. Although the use of SABR increased in England over this study period, it has still not reached levels of use seen in other countries. This study also highlights that one quarter of stage I NSCLC patients overall received no active treatment.
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Affiliation(s)
- I Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - S Sandhu
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - M Lüchtenborg
- National Cancer Registration and Analysis Service, Public Health England, London, UK; Cancer Epidemiology, Population and Global Health, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Harden
- National Cancer Registration and Analysis Service, Public Health England, London, UK.
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Hoeijmakers F, Beck N, Wouters MWJM, Prins HA, Steup WH. National quality registries: how to improve the quality of data? J Thorac Dis 2018; 10:S3490-S3499. [PMID: 30510784 PMCID: PMC6230825 DOI: 10.21037/jtd.2018.04.146] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/18/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Data of quality registries are increasingly used by healthcare providers, patients, health insurance companies, and governments for monitoring quality of care, hospital benchmarking and outcome research. To provide all stakeholders with reliable information and outcomes, reliable data are of the utmost importance. METHODS This article describes methods for quality assurance of data-used by the Dutch Institute for Clinical Auditing (DICA)-regarding: the design of a registry, data collection, data analysis, and external data verification. For the Dutch Lung Cancer Audit for Surgery (DLCA-S) results of data analysis and data verification were assessed with descriptive statistics. RESULTS Of all registered patients in the DLCA-S in 2016 (n=2,391), 98.2% was analysable and completeness of data for calculations of transparent outcomes was 90.7%. Data verification for the year 2014 showed a case ascertainment of 99.4%. Of 15 selected hospitals, 14 were verified. All these hospitals received the conclusion 'sufficient quality' on case ascertainment, mortality (0% under-registration) and complicated course (3.3% wrongly registered complications). One hospital was not able to deliver patients lists, and therefore not verified. CONCLUSIONS Quality of data can be promoted in many different ways. A completeness indicator and data verification are useful tools to improve data quality. Both methods were used to demonstrate the reliability of registered data in the DLCA-S. Opportunities for further improvement are standardised reporting and adequate data extraction.
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Affiliation(s)
- Fieke Hoeijmakers
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Naomi Beck
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michel W. J. M. Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgical oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hubert A. Prins
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Willem H. Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
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Kennedy MPT, Cheyne L, Darby M, Plant P, Milton R, Robson JM, Gill A, Malhotra P, Ashford-Turner V, Rodger K, Paramasivam E, Johnstone A, Bhartia B, Karthik S, Foster C, Lovatt V, Hewitt F, Cresswell L, Coupland VH, Lüchtenborg M, Jack RH, Moller H, Callister MEJ. Lung cancer stage-shift following a symptom awareness campaign. Thorax 2018; 73:1128-1136. [PMID: 29950525 DOI: 10.1136/thoraxjnl-2018-211842] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. METHODS An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). FINDINGS Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). INTERPRETATION This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.
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Affiliation(s)
- Martyn P T Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Leanne Cheyne
- Department of Respiratory Medicine, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Michael Darby
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Paul Plant
- Department of Thoracic Medicine, Aintree University Hospital NHS Foundation Trust, Aintree University Hospital, Liverpool, UK
| | - Richard Milton
- Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Jonathan M Robson
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Alison Gill
- Department of Respiratory Medicine, York Hospitals NHS Foundation Trust, York, UK
| | - Puneet Malhotra
- Department of Respiratory Medicine, St Helens and Knowsley Teaching Hospitals NHS Trust, Lancashire, UK
| | - Victoria Ashford-Turner
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Kirsty Rodger
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Elankumaran Paramasivam
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Annette Johnstone
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Bobby Bhartia
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Shishir Karthik
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | | | - Veronica Lovatt
- St Gemma's Hospice, previously Leeds Primary Care Trust, Leeds, UK
| | - Francesca Hewitt
- Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - Louise Cresswell
- Public Health, Leeds City Council previously Leeds Primary Care Trust, Leeds, UK
| | - Victoria H Coupland
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Margreet Lüchtenborg
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Epidemiology, Population and Global Health Programme, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ruth H Jack
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Henrik Moller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
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