Understanding patterns of care and treatment inequities in lung cancer

Background

Each year, over 12,000 Australians are diagnosed with lung cancer and 9,000 die from it. It is the fifth most common cancer in Australia and the leading cause of cancer death. More men than women develop lung cancer. The risk of being diagnosed before the age of 85 is 1 in 13 for men and 1 in 22 for women.

Lung cancer also has the highest burden of disease – this means that lung cancer patients’ overall health is poorer than for those with any other cancer and survival is low. Our researchers are focussed on identifying the most effective ways to reduce the impact of lung cancer. In this study, the team examined the patterns of care for lung cancer patients in NSW.

Analysing data from the Sax Institute’s 45 and Up Study, the study included 647 newly diagnosed non-small cell lung cancer patients, which is the most common form of the disease.

The research

The team found that 35% of patients presented to an emergency department up to one month before or in the month of diagnosis. These patients had poorer health characteristics, including a high comorbidity score (i.e. other illnesses occurring in parallel to lung cancer). They were also more likely to be a recent ex-smoker, and they were more likely to be to be diagnosed with advanced stage disease.

The study also showed 92% of lung cancer patients had visited their GP at least three times in the six months prior to diagnosis, suggesting people who present to emergency are not using the emergency department as their primary point of contact but were also using other healthcare channels prior to diagnosis.

Importantly, nearly 1 in 3 patients did not receive any anti-cancer treatment up to one year after diagnosis. The team found potential inequities in treatment, with older patients or patients who had no private health insurance less likely to receive treatment.

The impact

The study shows that the pathways to a lung cancer diagnosis are complex. Often, patients have a number of other illnesses and non-specific symptoms, which leads to diagnostic difficulty and delays in diagnosis. For many lung cancer patients, poor survival is attributable to being diagnosed at an advanced stage.

The findings highlight the need to identify opportunities to diagnose lung cancer earlier and to optimise treatment pathways for all patients to achieve improvements in outcomes.