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. 2014 Feb 21;9(2):e89426.
doi: 10.1371/journal.pone.0089426. eCollection 2014.

Small-cell lung cancer in England: trends in survival and chemotherapy using the National Lung Cancer Audit

Aamir Khakwani  1 , Anna L Rich  2 , Laila J Tata  1 , Helen A Powell  3 , Rosamund A Stanley  4 , David R Baldwin  2 , Richard B Hubbard  3
Affiliations

Small-cell lung cancer in England: trends in survival and chemotherapy using the National Lung Cancer Audit

Aamir Khakwani et al. PLoS One. .

Abstract

Background: The purpose of this study was to identify trends in survival and chemotherapy use for individuals with small-cell lung cancer (SCLC) in England using the National Lung Cancer Audit (NLCA).

Methods: We used data from the NLCA database to identify people with histologically proven SCLC from 2004-2011. We calculated the median survival by stage and assessed whether patient characteristics changed over time. We also assessed whether the proportion of patients with records of chemotherapy and/or radiotherapy changed over time.

Results: 18,513 patients were diagnosed with SCLC in our cohort. The median survival was 6 months for all patients, 1 year for those with limited stage and 4 months for extensive stage. 69% received chemotherapy and this proportion changed very slightly over time (test for trends p = 0.055). Age and performance status of patients remained stable over the study period, but the proportion of patients staged increased (p-value<0.001), mainly because of improved data completeness. There has been an increase in the proportion of patients that had a record of receiving both chemotherapy and radiotherapy each year (from 19% to 40% in limited and from 9% to 21% in extensive stage from 2004 to 2011). Patients who received chemotherapy with radiotherapy had better survival compared with any other treatment (HR 0.24, 95% CI 0.23-0.25).

Conclusion: Since 2004, when the NLCA was established, the proportion of patients with SCLC having chemotherapy has remained static. We have found an upward trend in the proportion of patients receiving both chemotherapy and radiotherapy which corresponded to a better survival in this group, but as it only applied for a small proportion of patients, it was not enough to change the overall survival.

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Conflict of interest statement

Competing Interests: I have read the journal’s policy and have the following conflicts: RBH has a grant provided by the British Lung Foundation chair of respiratory epidemiology and had a minor consultancy role (as an epidemiologist) with the GSK concerning people with lung fibrosis where he was paid £350. The fee was for advice in designing a biomarker cohort study for people wth idiopathic pulmonary fibrosis. He is also a co-applicant on a grant for £500,000 from GSK to look at biomarkers for lung fibrosis. AK is also doing his PhD from the University of Nottingham on a studentship provided by the British Lung Foundation. LJT has conducted the statistical analysis for the National Lung Cancer Audit annual reports for the past 4 years, which was funded by the Health and Social care Information Centre; LJT has not received any personal earnings from the HSCIC for this work. RAS was previously employed by the HSCIC as the project manager for the NLCA. The others have declared that no competing interest exists. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Kaplan-Meier curve estimates adjusted for age, sex, PS and co-morbidity by treatments received: (a) for whole cohort, (b) for SCLC limited and (c) for SCLC Extensive.
See this image and copyright information in PMC

References

    1. National Institute for Health and Care Excellence (Feburary 2005) The Diagnosis and Treatment of Lung Cancer: Methods, evidence & guidance.
    1. Riaz SP, Luchtenborg M, Coupland VH, Spicer J, Peake MD, et al. (2012) Trends in incidence of small cell lung cancer and all lung cancer. Lung Cancer 75: 280–284. - PubMed
    1. National Institute for Health and Clinical Excellence (April 2011) Lung Cancer: The diagnosis and treatment of lung cancer.
    1. Health and Social Care Information Centre (2010) National Lung Cancer Audit 2010.
    1. Health and Social Care Information Centre (2011) National Lung Cancer Audit Report 2011.

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