Patterns of care for small cell lung cancer in Victoria Australia. A prospective population-based observational study.

Abstract

Introduction: Small cell lung cancer (SCLC) is an aggressive cancer, often metastatic at presentation and with a poor prognosis. Study of patterns of care enables the evaluation of the dissemination of state-of-the-art cancer therapy and diagnostics into community oncology practice to identify patient-, provider-, and system-level factors that are associated with receipt and utilization of cancer care and survival outcomes. The patterns of care for SCLC remain incompletely defined in the Australian population. Methods: We aimed to analyse and report on the patterns of care for people diagnosed with SCLC in Victoria and to identify clinical quality indicators that can be used for benchmarking quality of cancer care. All patients diagnosed with SCLC between April 2011 and 18th December 2019 with data prospectively registered in the Victorian Lung Cancer Registry (VLCR) were included. Data collected included patient characteristics, treatments, and overall survival. We assessed survival using Kaplan Meier estimates and explored impacts of patient, disease, management related impacts on survival using cox proportional hazards regression analysis. Results: Over the study period, 1006 people (43% female) were included with a median age of 69 years. Performance status was documented for 66% of cases with 74% ECOG 0-1 at diagnosis. Staging using limited or extensive (VA) or TNM was documented in 89% cases with 70% stage extensive (ES)/stage IV and 30% limited (LS)/stage I-III. Documentation of supportive care screening was evident for 37.4%, MDM discussion for 55% cases and palliative care referral 39%. Active treatment with systemic anti-cancer treatment (SACT), radiotherapy or surgery or a combination was delivered to 89% overall with chemotherapy 84% (carboplatin-etoposide doublet 83%), radiotherapy 46%, combined chemo-radiotherapy 42% and 2% surgery. Median overall survival for all cases was 8.9 months, 16 months for LS and 7 months for ES and 8 months for un-staged Figure 1. Survival was adversely affected in multivariate analysis by increasing age OR 1.03 (1.02-1.03, 0.000), ECOG 3-4 2.33 (1.64-3.33, 0.000) and improved by MDM presentation OR 0.66 (0.58-0.77, 0.000) and multimodality treatment OR 0.42 (0.36-0.49, 0.000) or no treatment 3.0 (2.44-3.67, 0.000). Conclusions: Active treatment for SCLC and use of chemotherapy is high in Victoria with survival outcomes comparable to international series. Successful and meaningful future reporting of patterns of care in lung cancer will be dependent on the availability of a dataset fit for purpose. Improving documentation and establishing clinical quality indicators for SCLC could be beneficial for improving patient care.