133P Trends in incidence and mortality of lung cancer in Switzerland: Possible explanations and open questions

Abstract

Using US population-level data, it has been suggested that novel treatment advances, particularly targeted therapies, have contributed to a sharp fall in NSCLC mortality. Switzerland is a high-income country, with a universal, highly performant health care system, easy access to novel drugs but with different dynamics concerning the smoking epidemic than the US. We use population-based data from Swiss cancer registries to analyze the trends in incidence, mortality and survival and relate them to recent drug approvals. Decreases in lung cancer incidence-based mortality rates were observed from 2004 to 2018 (29·3 [26·7;32·2] vs 24·7 [22·7;26·9]. However, sex differences were apparent with a steep mortality decrease for men (46·7 [41·8;52·2] vs 33·4 [30·0;37·3]) and a modest increase in women (15·4 [12·9;18·5] vs 17·1 [14·8;19·9]) These modest decreases in mortality rates were observed for NSCLC (23·1 [20·9;25·7] vs 20·6 [18·7;22·6]) and for SCLC (6·1 [4·9;7·7] vs 4.1 [3·3;5·2]). Yet, in men there was a decrease in mortality due to NSCLC (37·2 [32·9;42·1] vs 28·1 [25;31·7]) and SCLC (9·5 [7·3;12·3] vs 5·3 [4;7·1]), while in women, mortality rates increased slightly for NSCLC (12·1 [9·9;14·9] vs 13·9 [11·9;16·5]) and remained stable for SCLC (3.·3 [2·2;5·2] vs 3·2 [2·2;4·7]). When comparing the 2004-2008 and 2014-2018 periods, we observed a significant increase in 1-year (45·7% [44·7;46·7] vs 55·8% [55·1;56·5]) and 5-year (17·3 [16·5;18·1] vs 27·9 [27;28·7]) lung cancer survival. Increases in survival were observed for NSCLC (1-year: 47·2 [46·1;48·3] vs 58·1 [57·4;58·9]; 5-year: 19·1 [18·2;20] vs 30·5 [29·6;31·4]) but were less evident and not statistically significant for SCLC ( 1-year: 36·3 [33·6;38·9] vs 39 [36·5;41·6]; 5-year: 6·7 [5·2;8·5] vs 10 [8·1;12·1]). The same trends were not different according to sex. This analysis shows a steeper reduction in incidence-based mortality than in incidence. While true improvements may be driven by early detection., better multidisciplinary care including surgery, radiotherapy, systemic treatments, and palliative and supportive care These findings are the results of multifactorial improvement in care rater than a unique cause to lower mortality.