Effectiveness of third-generation chemotherapy on the survival of patients with advanced non-small cell lung cancer - a national study
Christian von Plessen 1*, Trond-Eirik Strand 2, Tore Wentzel-Larsen 3, Ernst Omenaas 4, Nils Wilking 5, Stein Sundstrøm 6 and Sverre Sörenson 7
1 Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway, Norway
2 Cancer Registry of Norway, Norway
3 Centre for Clinical Research, Haukeland University Hospital, Norway
4 Centre for Clincial Research, Haukeland University Hospital, Norway
5 Karolinska Institute, Sweden
6 Department of Oncology, St. Olav's University Hospital, Trondheim, Norway
7 Department of Pulmonary Medicine, Linköping University Hospital and University of Linköping, Sweden
* To whom correspondence should be addressed. E-mail: christian.von.plessen{at}helse-bergen.no.
Accepted 11 March 2008
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Background: Chemotherapy is the primary treatment option for patients with advanced non-small cell lung cancer (ANSCLC). We investigated whether the introduction of modern third-generation chemotherapy was associated with survival benefits in a national population of patients with ANSCLC, and explored geographic and temporary variations of the utilisation of chemotherapy.
Methods: We included all patients with ANSCLC in the national Cancer Registry of Norway during 1994-2005. Using sales of vinorelbine as an indicator for third-generation chemotherapy we calculated annual county utilisation rates. We compared survival before and after the general introduction of third-generation chemotherapy and investigated associations between survival and variations of chemotherapy utilisation in Norwegian counties. In a subgroup, we compared survival of patients with and without a registered chemotherapy procedure code and explored predictors of having received chemotherapy.
Results: Of 24875 registered patients with lung cancer, 13757 had ANSCLC. The annual utilisation of the indicator drug in Norway increased from 3.7 (1998) to 184.2 grams (2005). Variations in utilisation across counties diminished threefold during 1999-2005. Median survival increased from 149 to176 days (P<0.001). The adjusted hazard ratio (HR) for a diagnosis after the introduction of vinorelbine was 0.93 (95%CI 0.88-0.99). County utilisation rates of vinorelbine (increments of 100 mg/1000 inhabitants) were inversely associated with the risk of death (HR=0.84, 95%CI 0.73-0.98). One-year survival with and without chemotherapy was 33.8% and 22.4% (P<0.001); HR=0.63 (95%CI 0.60-0.66). County of residence predicted chemotherapy utilisation with odds ratios in the range 0.13 (95%CI 0.1-0.19) to 1.04 (95%CI 0.64-1.69; a county (Troms) with traditionally high utilisation as reference entity).
Conclusion: Utilisation of third-generation chemotherapy was associated with slightly increased survival of patients with ANSCLC in this national population. Geographic and temporal variations of chemotherapy utilisation indicate deficiencies of the quality of delivered care.
