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Varying treatment could be ‘cutting short lives of hundreds of lung cancer patients’

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Differences approaches take by clinical teams to the active treatment of lung cancer across England may be cutting short the lives of hundreds of patients with the disease every year, warn researchers.

They calculated that if treatment rates rose to optimal levels, 800 patients could “have a clinically relevant extension of their lives each year”.

“The extent of use of different treatment modalities varies between geographical areas in England”

Study authors

They noted that lung cancer survival in England was worse than in comparable countries, with various factors, such as speed of diagnosis and access to cancer services, thought to be factors.

The researchers highlighted that they wanted to know if geographical variations in treatment might also have a role in lung cancer survival rates across the country.

As a result, they retrieved national cancer registry information on the survival of people who had been diagnosed with lung cancer between 2005 and 2014.

The one-year survival 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, the figures showed.

The researchers then looked in detail at active treatment – surgery, radiotherapy, and chemotherapy – and its potential links with survival in 176,225 patients diagnosed from 2010-14.

Their detailed analysis of the period showed considerable variations in use of active treatment, which was in turn associated with survival rates.

“The data suggest improvement over time, but there is potential for further survival gains2

Study authors

For example, 9.3% had surgery in the bottom fifth of active treatment areas, compared with 17% in the top fifth. Similarly, radical radiotherapy varied from 4% to 13%, and chemotherapy from 21.5% to 34.5%.

The more active the treatment, the longer survival tended to be, noted the researchers in the journal Thorax.

They calculated that the variation added up to 188 potentially avoidable annual deaths in the first two years after diagnosis for those not actively treated with surgery, plus 373 deaths for those not actively treated with radiotherapy.

Similarly, 318 deaths could have been delayed at the six-month time point if patients had been as actively treated with chemotherapy as they were in the top five performing areas.

Chemotherapy treatment rates did not affect two-year survival rates, possibly because more advanced lung cancer tended to have a poor outlook irrespective of what treatment is given.

However, the annual toll of avoidable deaths could be 800 if active treatment reached the rates of the top five performing areas, according to the researchers.

They noted that their calculations held true after taking account of underlying conditions, age, sex and tumour stage.

The study authors stated: “The extent of use of different treatment modalities varies between geographical areas in England.

“These variations are not attributable to measurable patient and tumour characteristics, and more likely reflect differences in clinical management between local multi-disciplinary teams,” said the researchers from London, Leeds, Leicester, Nottingham and Denmark.

“The data suggest improvement over time, but there is potential for further survival gains if the use of active treatments in all areas could be increased towards the highest current regional rates,” they said.

But the researchers added that “even the highest treatment rates that we observed are still below the levels required for optimal survival outcomes”.

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