Uncovering gaps in personalised lung cancer care in Germany: a white spot analysis

Abstract

Background: Lung cancer is among the most prevalent and deadly cancers, with around 57,000 new cases annually in Germany. Despite advances in targeted therapies, many patients still lack sufficient access to state-of-the-art comprehensive molecular diagnostics and personalised therapy throughout the disease course. This study identifies gaps in access to personalised lung cancer care in Germany. A primary objective was to analyse how many lung cancer patients are not captured by the established quality and network structures - namely, centres of the national Network Genomic Medicine (nNGM) and the lung cancer centres certified by the German Cancer Society (DKG) - to identify and ultimately close these gaps.

Methods: Publicly available data were used from inpatient quality reports, the databases of nNGM and certified lung cancer centres (DKG-LZ), the outpatient specialist medical care programme (ASV) supplemented by incidence data from the German Centre for Cancer Registry Data (2022). Differences among nNGM, DKG-LZ and ASV were assessed, focusing on non-affiliated hospitals as proxies for putative lack of quality-assured molecular diagnostic access. Geographic mapping was used to visualise regional disparities.

Results: The analysis included 993 hospitals with a total of 167,216 reimbursed lung cancer cases. 240 hospitals with 98,797 cases (59%) are affiliated with the nNGM. 108 hospitals with 78,591 cases (47%) are certified or cooperate with a DKG-LZ. ASV is provided at 152 hospitals or ASV partner hospitals (71,763 cases, 43%). nNGM and DKG jointly cover 276 hospitals and 114,472 cases (69%). Adding ASV, overall quality-affiliated coverage increases to 124,419 cases (74%). However, 668 hospitals with a total of 42,797 cases (26%) are not affiliated with any of these structures. Geographic analysis revealed regional disparities, notably in Northern Brandenburg, Lower Saxony, and Saxony-Anhalt characterised by high-incidence areas and non-affiliated hospitals managing large volumes of lung cancer cases.

Conclusions: Significant disparities in access to quality-assured molecular diagnostics persist. Expanding nNGM and integrating high-volume hospitals could raise coverage to over 85%. Standardising molecular diagnostics and quality requirements across nNGM, DKG, and ASV could further optimise access to high-quality personalised lung cancer care in Germany and build a unified real-world evidence base for equitable, consistent care.

Keywords: Comprehensive molecular diagnostics; Incidence-based evaluation; Inpatient real-world data; Personalised medicine in lung cancer; Quality-assured clinical networks; White spot analysis.

Fig. 1

Consort diagram, shows the number of hospitals and cases included in the survey and the coverage by the nNGM

Fig. 2

Consort diagram: Figure of coverage of hospitals with C34 cases by nNGM, nNGM + DKG-LZ, nNGM + DKG-LZ + ASV/lead teams and hospitals without connection

Fig. 3

Single and shared coverage by reimbursed case numbers and connection to nNGM, DKG and ASV

Fig. 4

Hospitals without connection to nNGM, DKG-LZ or ASV according to number of reimbursed cases

Fig. 5

Map of Germany showing hospitals either associated with nNGM (as nNGM centre or contracted regional network partner) or not associated with nNGM

Fig. 6

Map of Germany showing hospitals without affiliation to structures A-C, stratified by number of reimbursed lung cancer cases

Fig. 7

Map of Germany showing areas with long distances to the nearest nNGM-affiliated hospital, with hospitals stratified by number of reimbursed lung cancer cases

Fig. 8

Map of Germany showing pathology institutes connected to ASV but not affiliated with nNGM. Highlighted areas indicate regions where the nearest nNGM-affiliated hospital is located more than 30 km away