Roz Stanley

Clinical management of older people with non-small cell lung cancer in England

Data for 25261 patients with non-small cell lung cancer whose details were submitted to the National Lung Cancer Audit in England were analysed to assess the effect of age at diagnosis on their clinical management, after accounting for sex, stage, performance status and comorbidity. Multivariate logistic regression showed the odds of having histocytological confirmation and anticancer treatment decreased progressively with age, and was also lower in women. It is likely that these results have a multifactorial explanation, and further research into the attitudes of patients, carers and healthcare professionals, and clinical trials of treatment in older populations, are necessary.

Non-small cell lung cancer in young adults: presentation and survival in the English National Lung Cancer Audit

BACKGROUND Non-small cell lung cancer (NSCLC) in young adults is a rare but devastating illness with significant socioeconomic implications, and studies of this patient subgroup are limited. AIM This study employed the National Lung Cancer Audit to compare the clinical features and survival of young adults with NSCLC with the older age groups. DESIGN A retrospective cohort review using a validated national audit dataset. METHODS Data were analysed for the period between 1 January 2004 and 31 December 2011. Young adults were defined as between 18 and 39 years, and all others were divided into decade age groups, up to the 80 years and above group. We performed logistic and Cox regression analyses to assess clinical outcomes. RESULTS Of a total of 1 46 422 patients, 651 (0.5%) were young adults, of whom a higher proportion had adenocarcinoma (48%) than in any other age group. Stage distribution of NSCLC was similar across the age groups and 71% of young patients had stage IIIb/IV. Performance status (PS) was 0-1 for 85%. Young adults were more likely to have surgery and chemotherapy compared with the older age groups and had better overall and post-operative survival. The proportion with adenocarcinoma, better PS and that receiving surgery or chemotherapy diminished progressively with advancing decade age groups. CONCLUSION In our cohort of young adults with NSCLC, the majority had good PS despite the same late-stage disease as older patients. They were more likely to have treatment and survive longer than older patients.

Treatment decisions and survival for people with small-cell lung cancer

Background:Chemotherapy improves survival for many patients with SCLC, and hence it is important to understand variations in practice and outcomes for this treatment strategy.Methods:We used the National Lung Cancer Audit and Hospital Episodes Statistics to determine the proportion of patients who received chemotherapy for SCLC, and assess the effects of patient and organisational factors on the odds of receiving chemotherapy and of completing four cycles. We calculated median survival and used Cox regression to determine factors that predicted survival.Results:Of 15 091 cases of SCLC, 70% received at least one cycle of chemotherapy. More deprived people were less likely to receive chemotherapy, but patients were more likely to receive chemotherapy, and to complete ⩾four cycles, if they were referred to the lung cancer team by their GP. Median survival for those treated with chemotherapy was 12.9 months for limited and 7.3 months for extensive stage disease.Conclusions:The Linked NLCA and HES data provide real-life measures of survival in people treated with chemotherapy and show how this is influenced by patient and tumour characteristics. These data show the characteristics of patients who are less likely to complete a full course of treatment, an adverse predictor of survival.

Small cell lung cancer in the National Lung Cancer Audit

28 Small cell lung cancer in the National Lung Cancer Audit P. Beckett1, R.A. Stanley2, I. Woolhouse1, A. Yelland2, M.D. Peake1. 1Royal College of Physicians, London, United Kingdom, 2Information Centre for Health and Social Care, United Kingdom Introduction: The National Lung Cancer Audit is an audit of lung cancer and mesothelioma in the UK, which aims to record information about process and outcomes in lung cancer and through casemix adjustment start to explain the wide variations in outcome seen across the UK and between the UK and other Westernised countries. Methods: We have analysed all patients submitted to the Audit from English trusts with date first seen in 2008. Of 25,682 patients, 2,642 (10.3%) were confirmed to have SCLC. Results: The majority of these patients (69%) were between ages 60 79. 23% were recorded to have limited disease, 53% had extensive disease and stage data was not available in 24%. Performance status was recorded as PS 0 in 13%, PS 1 in 28%, PS 2 in 19%, PS 3 in 13% and PS 4 in 3%. Overall 63.4% were recorded to have received chemotherapy, with the proportion decreasing with increasing age and worsening PS (further details will be given in the poster). The proportion of patients having chemotherapy was 62% in extensive disease and 75% in limited disease. Comparison of the use of chemotherapy in the 30 cancer networks revealed a variation from 39% to 84% (further details to be included in poster). Conclusions: Overall, only two thirds of patients with SCLC receive chemotherapy and as expected the use of chemotherapy is related to age, PS and stage. There is a wide variation in chemotherapy use and networks with low rates of chemotherapy usage need to review their data and consider whether local guidelines and local processes need modification.