Key findings
Fifty-two percent of patients with resected (surgically removed) Stage II and IIA lung cancers and 44% of patients with unresected Stage IIIA and IIIB lung cancers received guideline-recommended treatment. We need more data on cancer stage and on patients’ health factors that influence their eligibility for treatment. This knowledge will enhance our ability to determine if eligible patients are getting the guideline-recommended treatment, and to use this information to improve the treatment of lung cancer.
|
Goal
|
|
Percentage of lung cancer patients treated with guideline-recommended chemotherapy following surgery
|
|
|
Percentage of lung cancer patients with unresectable disease treated with the guideline-recommended combined chemotherapy and radiation
|
|
What are the treatment guidelines for lung cancer?
Stage II non-small cell lung cancer is usually treated by surgical removal (resection) of the tumour. Some Stage IIIA cases may also be resectable. However, surgery alone is not always enough to eliminate the disease and prevent it from returning (recurrence). Research shows that for medically fit patients, treatment with chemotherapy after the surgery improves survival 1. Patients receiving platinum-based chemotherapy at a regional cancer centre within 120 days of the date of surgery are considered to be treated according to the lung cancer treatment guidelines 2.
For locally advanced non-small cell lung cancers that cannot be surgically removed, research shows treatment with combined chemotherapy and radiation improves survival 3. Patients who begin radiation therapy and platinum-based chemotherapy within 180 days of diagnosis are considered to be treated according to the lung cancer treatment guidelines.
What’s new this year?
This report presents new data for the period April 2006 to March 2008. Some minor methodological modifications have been applied to this year’s calculations. See the Technical Information section for more information.
 Figure 1: Percentage of Stage II or IIIA resected non-small cell lung cancer patients treated with guideline-recommended adjuvant chemotherapy following surgery versus other treatment, by LHIN of patient residence (patients resected between April 2006 and March 2008)
 Figure 2: Standardized percentage of Stage II or IIIA non-small cell lung cancer patients treated with guideline-recommended adjuvant chemotherapy following surgery, by LHIN of patient residence (patients resected between April 2006 and March 2008)
 Figure 3: Percentage unresected Stage IIIA or IIIB non-small cell lung cancer patients treated with guideline-recommended chemo-radiation versus other treatments, by LHIN of patient residence (patients diagnosed between April 2006 and March 2008)
 Figure 4: Standardized percentage of unresected Stage IIIA or IIIB non-small cell lung cancer patients treated with guideline-recommended chemo-radiation, by LHIN of patient residence (cases diagnosed between April 2006 and March 2008)
What do the results show?
Over half of Stage II or IIIA resected non-small cell lung cancer patients treated according to guidelines
Overall, 52% of patients received guideline-recommended chemotherapy following surgery. Fifteen percent of cases received a treatment different from that recommended in the guideline (different drug regimen and/or radiation therapy). Thirty-three percent of cases examined had no treatment reported within 120 days of the surgery. This may be partially explained by factors for which data is not available, such as medical fitness for treatment, patient choice, or treatment outside Ontario (Figure 1a).
Some variation exists among LHINs
Wide variation exists across Local Health Integration Networks (LHINs) in how well the guideline recommendations were followed for patients with Stage II and IIIa resected (surgically removed) non-small cell lung cancer. The standardized rate ranged from 32% to 66%. None of the LHIN results showed a statistically significant difference from the provincial average (Figure 1b).
Forty-four percent of Stage IIIA or IIIB unresected non-small cell lung cancer patients treated according to guidelines
Overall, 44% of patients received guideline-recommended chemo-radiation treatment. Another 31% of cases received an alternate treatment that may have been radiation therapy only or chemotherapy only, or combined chemo-radiation using a non-platinum-based drug. Twenty-five percent of cases had no treatment reported within 180 days of diagnosis (Figure 2a).
Considerable variation among LHINs
There was wide variation across LHINs in the percentage of patients receiving treatment according to the guidelines, with regional averages ranging from 20% to 59%. However, only 3 LHINs had a rate considered statistically significantly different from the provincial average (2 lower and 1 higher than the provincial mean).
Why is this important to patient care?
Understanding how and why treatment practices vary can inform efforts to improve quality of care and associated outcomes. Treatment guidelines, based on evidence from the latest clinical research, are intended to help clinicians and patients choose the treatments that will lead to the most favourable outcomes.
Gaps in the data available to calculate the reports published here should not prevent us from publishing them. We hope that, over time, the review of these indicators will encourage hospitals to report better and more complete data that includes cancer stage. This will progressively improve our ability to measure, evaluate and improve patient care.
Data limitations
The indicator does not measure the percentage of all new incident cases with lung cancer in Ontario that receive treatment according to guidelines. This is because stage data are available only for those cases that are referred to a regional cancer centre and for which valid stage data are reported. This represents 50% of resected and 56% of unresected lung cancer cases treated in 2006-2007 and 2007-2008.
How does Ontario compare?
No jurisdictions with comparable data for this measure were identified.
What is being done?
Working to improve cancer stage data capture
The indicators presented here can be calculated only for cases with a valid stage reported by the cancer treatment centres; these cases represented only 50% of resected and 56% of unresected lung cancer cases in Ontario for the two fiscal years examined: 2006-2007 and 2007-2008. Cancer Care Ontario and the Regional Cancer Programs are working to broaden the capture of accurate cancer stage data for all newly diagnosed patients, including those who are treated in their local hospital and not referred to a regional cancer centre. They also are reviewing hospital level data both to refine the indicators, and to understand variations in treatment practice. By gaining a better understanding of differences in practice patterns, they will be better able to encourage and support change when it is needed. See Reporting of Cancer Stage at Diagnosis.
Continuing development of evidence-based practice guidelines
Through its Program in Evidenced-Based Care at McMaster University, Cancer Care Ontario works with Ontario clinicians to review the latest literature and maintain up-to-date evidence-based practice guidelines. See Number of Evidence-Based Reports for Cancer Care and Control.
Strengthening management of lung cancer
In 2009, Cancer Care Ontario is launching its Lung Cancer Disease Pathway Management initiative. This initiative will focus on identifying and promoting evidence-based practices to reduce the burden of lung cancer.
Notes
1 The International Adjuvant Lung Cancer Trial Collaborative Group: Cisplatin-Based Adjuvant Chemotherapy in Patients with Completely Resected Non-Small-Cell Lung Cancer. N Engl J Med 350:351-360, 2004
2 Alam N, Shepherd FA, Darling G, Mackay JA, Ung YC, Evans WK and members of the Lung Cancer Disease Site Group. Postoperative Adjuvant Chemotherapy, with or without Radiotherapy, in Completely Resected Non-Small Cell Lung Cancer: A Clinical Practice Guideline. A Quality Initiative of the Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO).
3 G. Okawara. J.A. Mackay, W.K. Evans, Y.C. Ung, and the PEBC Lung Cancer Disease Site Group: Management of Unresected Stage Ill Non-Small Cell Lung Cancer: A Clinical Practice Guideline. Program in Evidence Based Care, Cancer Care Ontario, Jan 2006
|