Patterns of care and outcomes for a clinical cohort of patients with lung cancer (2016-2021): Report on the Embedding Research (and Evidence) in Cancer Healthcare – EnRICH Program

Abstract

Despite advances in diagnosis and treatment, lung cancer continues to be the leading cause of cancer-related death in Australia. Survival outcomes remain disappointing with less than a quarter of patients (22%) alive five years after diagnosis.

Strategies to improve lung cancer care have focused on more rapid diagnosis and treatment from initial symptom presentation; a greater use of combined modalities of therapy; novel approaches using molecular-based diagnostics, targeted therapies, and immunotherapies; as well as a greater use of supportive and palliative care.

The Embedding Research (and Evidence) in Cancer Healthcare (EnRICH) Program has explored patterns of care and clinical outcomes in a cohort of 2000 real-world patients presenting to six major specialist cancer centres in NSW with a first diagnosis between September 2016 and October 2021.

This report provides valuable information on the natural history of patients following their initial diagnosis and maps out the use of evidence-based care, as well as identifying important factors defining overall prognosis. The report identifies that tumour stage at diagnosis remains one of the most important prognostic factors for both non-small cell (NSCLC) and small cell (SCLC) lung cancer. In NSCLC, stage, age, sex, performance status, co-morbid illness, neutrophil to lymphocyte ratio, haemoglobin levels, non-English speaking background, and mutation status are each independent factors predicting survival outcomes. Stage, performance status, and neutrophil to lymphocyte ratio are also predictive of survival in SCLC lung cancer.

Overall, patients at major specialist cancer centres in NSW have done relatively well compared with other Australian cohorts such as those included in the Victorian Lung Cancer Registry and the Queensland Lung Cancer Quality Index, but it is important to note that the EnRICH cohort only includes those seen at least once at a major specialist cancer centre and does not represent all patients with lung cancer in these regions – a topic being further investigated in a subsequent report.

Several quality indicators of cancer care are being captured and fed back to NSW practitioners and health administrators to inform practice and service development. While these indicators are comparable with other regions, there remain areas for improvement - a focus of ongoing work. Reassuringly, quality of care and outcomes for patients in the EnRICH cohort were not adversely affected by health service disruptions during the COVID-19 pandemic.

Through this effort we hope to better document current outcomes of patients with lung cancer and the care they receive with the aim of improving current evidence-based care and accelerating the uptake of new emerging evidence.