BACKGROUND
Lung cancer continues to be the most common cause of cancer-related death, morbidity and burden of disease in NSW and across Australia. There is an ongoing need to ensure patients receive optimal evidence-based care to achieve best possible outcomes. The EnRICH Program was established to: describe the natural history and patterns of care for lung cancer; identify gaps in evidence and practice for clinical quality improvement; and create a platform for translational cancer research.
AIM
To describe real-world patterns of care and outcomes for patients enrolled in the EnRICH Program from 2016 to 2021.
METHODS
Sample: Patients over 18-years with a new diagnosis of primary lung cancer (any type, any stage) presenting to defined clinical sites in metropolitan and regional NSW.
Data: Data are collected from patient medical records and hospital administrative datasets at diagnosis, three-, six-, and 12-months post-diagnosis, then annually until death or five-year follow-up.
Statistics: Key variables of interest were described for NSCLC and SCLC cohorts. One-year overall (OS) and progression-free (PFS) survival were compared using Kaplan-Meier estimates. Multivariable best subset selection was used with Cox regression to determine optimal prognostic models.
RESULTS
2000 patients diagnosed September 2016 - October 2021 were included in analyses. Patient characteristics were consistent with the Australian lung cancer population; median age 70-years, 54% male, 18% never-smokers. Similar numbers were diagnosed with NSCLC (86%) however, fewer patients were diagnosed with SCLC (10%), and with advanced-stage disease (41%) than is typical.
The majority had some form of anti-cancer treatment (84% first-line therapy within 3 months of diagnosis, 95% first-line therapy at any time), with more than three-quarters of those with early-stage disease (77%) undergoing surgical resection.
In NSCLC, in multivariable analyses, male sex, older age (>80-years), more advanced stage, poorer performance status, lower haemoglobin (Hb) levels, an elevated neutrophil to lymphocyte (NLR) ratio, and comorbid illness were significant prognostic indicators of poorer OS. Conversely, OS was better in non-English speakers and those with an actionable mutation (EGFR/ALK). The same factors, plus increased levels of gamma-glutamyl transferase (Gamma GT), symptomatic of liver metastases, and low creatinine clearance, were prognostic for poorer PFS.
In SCLC, in multivariable analyses, extensive-stage disease, poor performance status, and an elevated neutrophil to lymphocyte ratio (NLR) were significant prognostic indicators of poorer OS and PFS.
CONCLUSION
This analysis provides real-world data on contemporary care and outcomes for a clinical cohort of 2000 patients with lung cancer in NSW.