Lung cancer treatment variations
7th March 2018 – Where you live in England can affect your chances of surviving lung cancer because of variations in treatment, according to a study.
The researchers estimate if treatment across the country rose to match the top 5 performing areas then each year 800 patients with lung cancer could have their lives extended.
Each year in the UK around 46,400 people are diagnosed with lung cancer. It is the nation's third most common cancer and in most people, although not all, can be linked to smoking.
Your chances of surviving lung cancer if you live in England are worse than in other comparable countries, with factors such as speed of diagnosis and access to cancer services, thought to influence the survival rates.
A team of English and Danish researchers decided to take a look and see if where you lived in England also had a role in lung cancer survival rates.
The researchers collected information on the survival of people who had been diagnosed with lung cancer between 2005 and 2014.
There was some good news - the 1 year survival rate of lung cancer patients in England improved by one percentage point each year between 2005 and 2014, rising from 26% in 2005 to 36% in 2014.
If lung cancer is diagnosed early then surgery to remove the affected area may be recommended, otherwise the main treatment is radiotherapy and chemotherapy.
The researchers looked in detail at how 176,225 people with lung cancer diagnosed between 2010 and 2014 were treated. This analysis showed considerable variations in treatment, which in turn was associated with varying survival rates.
They calculated that there were up to 188 potentially avoidable deaths in the first 2 years after diagnosis for those not actively treated with surgery, and 373 potentially avoidable deaths for those not actively treated with radical radiotherapy. Also 318 deaths could have been delayed at the 6 month time point if all patients had been actively treated with chemotherapy in the way they were in the top 5 performing areas.
The research has been published online in the journal Thorax.
Lives cut short
The researchers say there were no obvious patient or disease factors driving the geographical differences. They calculate the lives of 800 lung cancer patients across the country could be extended if everyone was treated in the same way as they would have been if they lived in one of the top 5 highest performing areas.
Even then they conclude that "the highest treatment rates that we observed are still below the levels required for optimal survival outcomes."
None of the areas, including the top 5 performing areas, were named in the study.
Commenting on the findings, Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, (RCLCF) comments in an emailed statement: "It is gratifying to see overall improvement in one-year survival for lung cancer over the last decade. Variation in active treatment - in particular, lung cancer surgery and radical radiotherapy - is worrying as these therapies offer the best chance of curative therapy. We have been aware of this variation for some time. This data shows the survival impact of that variation.
"This data underlines the importance, in particular, in those areas with lower one-year survival and lower active treatment rates, of early detection and optimal treatment pathways.
"Early detection is something RCLCF has campaigned on, over many years. As such, we were pleased to note the announcement by Simon Stevens [NHS England's chief executive] last November, of a roll out of CT screening lung health checks. We look forward to seeing the implementation plan (including timescales and areas covered).
"By way of ensuring lung cancer patients are treated optimally, the implementation of the Nationally Agreed Optimal Lung Cancer Pathway across the country, would ensure reduction in the treatment variation seen in this study and so, improve patient survival."