Patterns of care for people with small cell lung cancer in Victoria, 2011–19: a retrospective, population-based registry data study

Abstract

Objectives: To report stage-specific patterns of treatment and the influence of management and treatment type on survival rates for people newly diagnosed with small cell lung cancer (SCLC). Design: Cross-sectional patterns of care study; analysis of data prospectively collected for the Victorian Lung Cancer Registry (VLCR). Setting, participants: All people diagnosed with SCLC in Victoria during 1 April 2011 – 18 December 2019. Main outcome measures: Stage-specific management and treatment of people with SCLC; median survival time. Results: During 2011–19, 1006 people were diagnosed with SCLC (10.5% of all lung cancer diagnoses in Victoria); their median age was 69 years (interquartile range [IQR], 62–77 years), 429 were women (43%), and 921 were current or former smokers (92%). Clinical stage was defined for 896 people (89%; TNM stages I–III, 268 [30%]; TNM stage IV, 628 [70%]) and ECOG performance status at diagnosis for 663 (66%; 0 or 1, 489 [49%]; 2–4, 174 [17%]). The cases of 552 patients had been discussed at multidisciplinary meetings (55%), 377 people had received supportive care screening (37%), and 388 had been referred for palliative care (39%). Active treatment was received by 891 people (89%): chemotherapy, 843 (84%); radiotherapy, 460 (46%); chemotherapy and radiotherapy, 419 (42%); surgery, 23 (2%). Treatment had commenced within fourteen days of diagnosis for 632 of 875 patients (72%). Overall median survival time from diagnosis was 8.9 months (IQR, 4.2–16 months; stage I–III: 16.3 [IQR, 9.3–30] months; stage IV: 7.2 [IQR, 3.3–12] months). Multidisciplinary meeting presentation (hazard ratio [HR], 0.66; 95% CI, 0.58–0.77), multimodality treatment (HR, 0.42; 95% CI, 0.36–0.49), and chemotherapy within fourteen days of diagnosis (HR, 0.68; 95% CI, 0.48–0.94) were each associated with lower mortality during follow-up. Conclusion: Rates of supportive care screening, multidisciplinary meeting evaluation, and palliative care referral for people with SCLC could be improved. A national registry of SCLC-specific management and outcomes data could improve the quality and safety of care.