Original StudySteadily Improving Survival in Lung Cancer
Introduction
Lung cancer continues to be the leading cause of cancer death in men and women in the United States. In 2014 it is estimated there will be 1,665,540 new cases of invasive cancer diagnosed, including 116,000 (14%) lung cancer in men, and 108,210 (13%) lung cancers in women. In 2014 it is estimated that lung cancer will cause 86,930 (28%) cancer deaths in men, and 72,330 (26%) cancer deaths in women.1
During the past 3 decades there have been many perceived advances in the war against lung cancer, including antismoking initiatives,2, 3 earlier diagnosis through radiologic imaging,4 increased specialization of lung cancer surgery,5 less morbid surgical techniques,6 more focused and effective radiation therapy technologies,7 and a variety of systemic therapies including chemotherapy,8 monoclonal antibodies,9 and therapies that target aberrant signal transduction.10, 11 Multimodality approaches that have been increasingly adopted include combining radiation therapy and chemotherapy in the treatment of locally advanced lung cancer,12, 13, 14 and giving adjuvant chemotherapy after surgical resection.15 Brain metastases are easier to control since the advent of stereotactic radiation therapy.16
It is not clear how widely adopted many of these advances have been at the national level, but in our local catchment area that includes approximately 1 million residents in central and coastal Orange County in southern California, we have used a variety of educational venues directed to the community population and area physicians, in an effort to decrease the rates of lung cancer, and to increase the survival of patients diagnosed with invasive lung cancer. This has included smoking cessation programs, weekly lung cancer-specific case conferences, oncology grand rounds that periodically focus on lung cancer, a lung cancer support group, lung cancer symposia, participation in lung cancer clinical trials, and a radiologic lung cancer screening program. Although we have no easy means to determine whether the incidence of lung cancer has decreased in our community, we do have a robust cancer registry that we have used to record histologic diagnosis, stage at diagnosis, and survival for all patients diagnosed and/or treated with lung cancer in our community hospital, and in conjunction with the Hoag Cancer Center. We hypothesized that survival should have improved for area lung cancer patients who we believe have had access to medical care providers who are aware of advances in lung cancer care, and because of multidisciplinary case conferences and education programs as part of a comprehensive cancer program. We examined whether survival changed during the past 25 years, and how any changes in stage, histology, and treatment related to changes in survival.
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Patients and Methods
For this retrospective review, a waiver of consent under the Common Rule for the Protection of Human Subjects and a waiver of authorization under the Health Insurance Portability and Accountability Act were obtained from the Western Institutional Review Board, Olympia, Washington. The Hoag Cancer Center (now known as the Hoag Family Cancer Institute) database was used to identify patients with lung cancer diagnosed from 1986 to 2009, who were diagnosed and/or received some or all of their lung
Results
Table 1 summarizes the numbers of patients accessioned for each era, and their characteristics. In each successive era there was an increase in the numbers of patients diagnosed with lung cancer. There was an increase in the median age for each patient cohort with a trend test of 0.829. There was a substantial increase in the number and proportion of patients aged 80 years or older in the most recent era. The proportion of female patients did not change significantly from one period to the
Discussion
This study shows that survival for patients treated at 1 large community cancer program has steadily improved over the past 25 years, and has increased to higher levels than observed nationally. The explanation for this is undoubtedly multifactorial, but certainly includes a population of patients who enjoy a relatively high socioeconomic status with local access to high-quality health care, and includes a higher proportion of nonsmokers and former smokers than are found in many communities.
Conclusion
In terms of lung cancer, over time there have been steady increases in median age, and the proportions of patients who have adenocarcinoma, are female, have local stage disease, undergo surgery alone as therapy, and receive systemic therapy with surgery as initial treatment. These changes have been associated with a 13.3% absolute increase in observed survival and an 81% relative increase.
During the past 30 years the median survival of area patients with a new diagnosis of lung cancer has more
Disclosure
The authors have stated that they have no conflicts of interest.
Acknowledgments
Supported by Hoag Hospital. The authors thank medical oncologists Louis VanderMolen, Neil Barth, and Khosrow Mahdavi, cardiothoracic and thoracic surgeons Doug Zusman and Colin Joyo, and radiation oncologists Russ Hafer and Craig Cox, who were the managing physicians of a large proportion of these patients; and biostatisticians Curtiss Church, Jim Cubellis, and David Jackson, for their assistance with statistical analyses.
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