Abstract 3180
Background
Clinical trials define treatment recommendations but patients in the real world may be unable or unwilling to undergo treatments with demonstrated efficacy in fit patients. The Canadian Partnership Against Cancer has developed a model of lung cancer (LC) management (OncoSim-lung) in 2008 based on clinical trials data and expert advice. To credibly project the future clinical and economic impacts of cancer control measures using OncoSim, the model has been refined using real-world data.
Methods
Treatment data by histology and stage were extracted from the Ontario Cancer Registry for LC cohorts diagnosed in 2010 and 2013. All incident cases that satisfied the IARC rule of a new primary were included. Missing or unknown stage cases were excluded. Clinical pathways were validated by oncologists from different disciplines across Canada.
Results
The 2013 cohort included 8,086 staged LC: NSCLC (n = 7,143) Stage I 18.7%, II 8%, III/IIIa 11.4%, IIIb 4.9% IV 56.8%; SCLC (n = 943) limited 67.7%, extensive 32.3%. Of 813 stage III/IIIa patients, only 26% underwent surgery, 41% of whom received adjuvant chemotherapy or postoperative radical radiotherapy (16%); 13% received trimodality treatment. Of the 75% of Stage III not receiving surgery, 26% had NAT and 21% had palliative radiotherapy alone. Of those receiving active treatment, 20% received combined chemo +radiotherapy and 13% each had chemotherapy alone or radical radiotherapy alone. Of 356 stage IIIb patients, 17% had NAT, 28% received palliative radiotherapy and only 30% had chemo + radical radiotherapy. 18% had chemo alone. Of 4055 stage IV NSCLC, 47% had NAT, 24% received chemotherapy alone and 23% had palliative radiotherapy only. Of those who received first-line chemotherapy (n = 1059), 47% received second line chemotherapy and of those, 37% received third line therapy.
Conclusions
Compared to prior expert opinion, there was a much lower frequency of chemo-radiotherapy in Stage III disease and a higher frequency of NAT across all stages of disease. The updated OncoSim model will now have a credible real-world base from which the impacts of new treatment interventions on survival and budget impact can be better estimated.
Clinical trial identification
Legal entity responsible for the study
Canadian Partnership Against Cancer.
Funding
Canadian Partnership Against Cancer.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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