Trends on clinical characteristics and medical service use of lung cancer in China 2005–14: a multicentre retrospective survey

Abstract

BackgroundNationwide data on clinical diagnosis and treatment of lung cancer is scarce in China. The aim of this study was to investigate the 10-year profile of lung cancer on clinical characteristics and medical service use in China. MethodsThis study was a hospital-based multicentre retrospective survey. Patients diagnosed with primary lung cancer in tertiary hospitals during 2005–14 were selected from seven geographic regions of China. One month was randomly chosen to represent one year for each hospital by allocating a random number, and 100 cases were included for each month. Inclusion criteria included age 18 years or older, available data on pathological type, stage, and therapy regime. We used a structured questionnaire, designed by a multidisciplinary expert panel of the National Cancer Center of China, to extract information via medical records, including demographic and clinical characteristics and medical service use. To protect patients' privacy, we allocated an identical ID for each patient and filtered the private information. We applied Cochran-Armitage χ2 test to trend analyses and χ2 test to geographical variations. This study was approved by Cancer Hospital, Chinese Academy of Medical Sciences Ethics Committee. FindingsOf 7184 included patients, mean age at diagnosis was 58·3 years (SD 10·2) and non-small cell lung cancer accounted for 6481 (90·2%) patients· Over the decade, the number of patients aged 60 years or older increased from 282 (41·2%) in 2005 to 460 (56·2%) in 2014 (p<0·0001; following data represented the year 2005 and 2014, respectively). The proportion of patients smoking decreased from 62·9% (418) to 51·1% (415; p<0·0001) and proportion of women increased from 23·5% (161) to 31·9% (261; p<0·0001). The proportion of advanced stage cancer (IIIb-IV) increased from 41·9% (279) to 47·4% (378; p<0·0001). Adenocarcinoma's proportion increased from 36·4% (236) to 53·5% (410; p<0·0001) while that of squamous carcinoma decreased from 45·4% (294) to 34·4% (264; p<0·0001). The application of chest X-ray dropped from 50·2% (343) to 31·0% (253; p<0·0001) but that of chest CT increased from 65·8% (450) to 81·4% (666; p<0·0001). As the most common used treatment options, chemotherapy (from 36·0% [246] to 36·4% [298]; p=0·2895) and surgery (from 28·8% [197] to 32·0% [262]; p=0·4970) remained stable. Significant difference of advanced stage cancer and chest CT usage were found among different geographical regions (p<0·0001), and more details will be reported elsewhere. InterpretationThe sustaining high smoking exposure, increase of female patients, and upstaging cancer demonstrate potential challenges and future directions on lung cancer prevention and control in China. Despite substantial changes of clinical characteristics, main treatment options remained unchanged, which merits further investigation. FundingNational Health and Family Planning Commission of China.