Abstract
ABSTRACTPurposeThe third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain.MethodsA population-based cohort study included all 1196 incident first invasive primary lung cancer (C33–C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients’ hospital medical records from all public and private hospitals from two regions in southern Spain.ResultsThere was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02–0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis.ConclusionsThe observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.
Highlights
Lung cancer was the third most frequently diagnosed cancer in Europe in 2018 with 364,601 new cases [1]
The most effective treatment regarding 2-year survival was the combination of radiotherapy, chemotherapy, and surgery, reducing the risk of death by 94% compared to patients who did not receive this combination of treatment (EMR = 0.06; 95% confidence intervals (CI) 0.02–0.16)
The present population-based study analyzed lung cancer net survival in patients diagnosed in two southern Spanish regions and showed geographical differences of patient, tumor, and healthcare provision determinants associated with 1- and 2-year net survival probability. 1-year age-standardized net survival for lung cancer in southern Spain is lower than the overall Spanish 1-year age-standardized net survival, i.e., 38% and the European, 39% [15, 24]
Summary
Lung cancer was the third most frequently diagnosed cancer in Europe in 2018 with 364,601 new cases [1]. We hypothesized that the regional variability in lung cancer survival could be characterized by patient, tumor, and healthcare provision determinants [16]. We develop a population-based cohort study including 1196 incident lung cancer cases from two population-based cancer registries in southern Spain (Huelva and Granada) following international standard procedures and coding rules (http://www.hrstudies.eu/). Cancer registry data related to patients’ sociodemographic and basic tumor characteristics were enhanced with information from hospital medical records including cancer diagnosis and treatment. If the diagnosis was based on a cytological or a histological evaluation, the disease was considered microscopically verified and was further classified by morphology: adenocarcinoma (ADC), squamous cells carcinoma (SqCC), small cells carcinoma (SmCC), large cells carcinoma (LCC), and other types Both microscopically verified and unverified lung cancer cases were included. We used Stata v. 14 (StataCorp, College Station, Texas, USA) for the statistical analysis [23]
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