Impact of early diagnosis and improved access to treatment on lung cancer survival

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.