Impact of early diagnosis and improved access to treatment on lung cancer survival
Mee, Thomas Brown, S. Kirkby, Norman Burnet, Neil G Faivre-Finn, Corinne Kirkby, Karen J
Mee, Thomas
Brown, S.
Kirkby, Norman
Burnet, Neil G
Faivre-Finn, Corinne
Kirkby, Karen J
Citations
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Abstract
Purpose or Objective
Lung cancer(LC) screening aims to improve early diagnosis
in patients at high risk. Trials have shown low-dose CT
screening can improve LC mortality by 20%1. If a successful
national screening program(NSP) is implemented, there
could be a large impact upon health services. SABR for
early stage LC is the standard of care for patients
unsuitable for surgery. However, SABR is not commissioned
in 30% of English radiotherapy(RT) centres2. Numbers of
patients who receive suboptimal conventional RT or no
treatment are unacceptably high compared to The
Netherlands(26% vs 9%)3.
The aim of this study is to estimate the increase of stage1
LC patients with a NSP and to estimate demand for SABR,
RT, surgery and no treatment in that population, using
current English rates and aspirational Dutch rates.
Material and Methods
Results from the Manchester Lung Health Check(MLHC)
pilot1 were applied to England, at a clinical commissioning
group(CCG) level, by using propensity score matching.
Stage data, age-banded incidence data, population data
and smoking statistics (all at CCG level) were used. We
estimated the number of LCs in each CCG that would be
eligible for screening and then applied a shift in stage at
diagnosis from the current level to a new MLHC CCGequivalent
level. This cohort of LC patients, with new
stage data, were then re-introduced to the rest of the LC
patients not in the screening program. Finally, an estimate
is made for the additional number of patients surviving for
at least 1 and 5 years4.
To show the impact upon health services for both the no-
NSP and NSP scenarios, stage1 LC treatment rates (SABR,
RT, Surgery and no treatment) were applied at CCG level
using English treatment rates (12%)3. This was repeated
using Dutch rates(41%)3.
Results
Stage1 patient numbers could increase by 115% if a NSP
was successfully implemented. This is an increase of ≈450
RT, ≈950 SABR and ≈4,000 surgical patients (Table 1a). 1
year survival would increase from 41% to 53%. 5 year
survival would increase from 16% to 26% (Table 1b&c).
If England treated with the same rates as the Dutch then
SABR patient numbers could increase by ≈2,000 patients
(Figure 1) with RT and surgical numbers decreasing.
If both a NSP and improvements to access occurred then it
could result in an extra ≈5,200 SABR patients, ≈130 RT
patients and ≈2,400 surgical patients per year. Conclusion
Survival rates for LC in England are lower than some parts
of Europe. This could be addressed by increasing access to
the latest treatments and by improving early diagnosis.
However, a health service has to be prepared for both
situations before successful implementation. Here we
have calculated the potential increase in stage1 patient
numbers and the service consequences.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Mee T, Brown S, Kirkby NF, Burnet NG, Faivre-Finn C, Kirkby KJ. OC-0074: Impact of early diagnosis and improved access to treatment on lung cancer survival. Radiotherapy and Oncology . 2020 Nov;152:S33–4.