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Abstract
Background: To investigate whether the introduction of modern third-generation chemotherapy was associated with survival benefits in a national population of patients with advanced non-small cell lung cancer (ANSCLC) and to explore geographical and temporary variations in the utilisation of chemotherapy.
Methods: All patients with ANSCLC in the Cancer Registry of Norway during 1994–2005 were included. Using sales of vinorelbine as an indicator for chemotherapy, annual county utilisation rates were calculated. Survival before and after the general introduction of vinorelbine and associations between survival and variations in utilisation in counties were investigated. In a subgroup, the predictors of having received chemotherapy were explored.
Results: Of 24 875 registered patients with lung cancer, 13 757 had ANSCLC. The annual utilisation of the indicator drug in Norway increased from 3.7 to 184.2 g (1998–2005). Median survival increased from 149 to176 days (p<0.001). The adjusted hazard ratio (HR) for a diagnosis after the introduction was 0.93 (95% CI 0.88 to 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 to 0.98). County of residence predicted chemotherapy utilisation with odds ratios in the range 0.13 (95% CI 0.1 to 0.19) to 1.04 (95% CI 0.64 to 1.69), a county with traditionally high utilisation as reference.
Conclusion: Utilisation of third-generation chemotherapy was associated with slightly increased survival of patients with ANSCLC. Geographical and temporal differences in utilisation indicate variable quality of delivered care.
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Footnotes
Funding: C v P has received scholarships from the Faculty of Medicine, University of Bergen as well as from the Western Norway Regional Health Authority and the Department of Thoracic Medicine, Haukeland University Hospital.
Competing interests: C v P has received support for travel to scientific conferences from Eli Lilly, Astra, Roche, Glaxo, and research grants from the Regional Health Authority of Western Norway and from the University of Bergen. He chairs the protocol committee of an ongoing clinical trial that has received an unrestricted grant from Pierre Fabre, the manufacturer of Navelbine (vinorelbine). N W has received research grants from European Union, Karolinska Institute, Roche, Stockholm Cancer Foundation and Stockholm County Counsel. He was an employee at Bristol Myers Squibb during 2001–3. S Sundstrom has received travel support for scientific conferences from Lilly, Roche, Novartis, Pierre Phabre and AstraZeneca. He has received an unrestricted grant from Eli Lilly for a study in 2005. S Sörenson received unrestricted grants for academic studies from Pierre Fabre, Aventis and Pfizer and support for travel to ASCO and IASCLC meetings from Roche, Pfizer, and Eli Lilly. The other authors have no conflicts of interest.
Ethics approval: The study was approved by the Regional Ethical Committee, Bergen, Norway and by the data protection authority (NSD).