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Objective: To examine the direct and indirect impact of comorbidity on the survival., Design: A historical cohort study., Setting: Denmark., Participants: All patients with non-small cell lung cancer who were registered in the Danish Lung Cancer Registry in 2010., Main Outcome Measures: The influence of comorbidity on stage misclassification, probability of resection and survival., Results: It was estimated that the comorbidity influences the probability of resection with OR 0.65 and 95% credible interval (0.54; 0.79), the staging process with OR 1.08 and 95% credible interval (0.96; 1.20), and the survival process with HR 1.08 and 95% credible interval (1.02; 1.14)., Conclusions: We found that comorbidity has a significant indirect effect on survival mediated by the resection process and a slightly direct effect on mortality.

Objective: Clinical stage (c-stage) at diagnosis is the most significant prognostic marker for patients with cancer, where 1- and 5-year survival rates as main landmarks when assessing outcomes. This is a population-based case study of Danish c-stage I lung cancer patients who were considered candidates for curative therapy and then died within 1 year after diagnosis (cases). Cases were identified in the Danish Lung Cancer Register (DLCR), and medical records were used to retrieve treatment details and cause of death (CoD). Our aims were, if possible, to identify and describe clusters of patients, in terms of CoD and treatment modality at risk for an adverse short-term outcome. Results: Patients who died early were more frequently male, older, had squamous-cell histology, were less frequently surgically treated and generally had a higher burden of comorbidity. In terms of CoD, 29% died of lung cancer with distant recurrence (DR) as the most common type of recurrence (55%). Death from co-morbidity occurred for 23%, where the largest proportion (36%) died from another cancer. Nineteen percentage died from treatment complications, with the majority being male (p<.001). The remainder died of unknown or other causes. Conclusions: Lung cancer with DR remains the most common CoD. Identifying and accordingly treating patients at risk for DR could potentially improve outcomes. Further studies of the predominantly male subgroup of patients who die of treatment complications are needed. Death from co-morbidity especially in patients with another cancer is a significant CoD and when assessing the quality of lung cancer care a competing event. [ABSTRACT FROM AUTHOR]

Introduction: Lung cancer outcomes in England are inferior to comparable countries. Patient or disease characteristics, healthcare-seeking behaviour, diagnostic pathways, and oncology service provision may contribute. We aimed to quantify associations between geographic variations in treatment and survival of patients in England.Methods: We retrieved detailed cancer registration data to analyse the variation in survival of 176,225 lung cancer patients, diagnosed 2010-2014. We used Kaplan-Meier analysis and Cox proportional hazards regression to investigate survival in the two-year period following diagnosis.Results: Survival improved over the period studied. The use of active treatment varied between geographical areas, with inter-quintile ranges of 9%-17% for surgical resection, 4%-13% for radical radiotherapy, and 22%-35% for chemotherapy. At 2 years, there were 188 potentially avoidable deaths annually for surgical resection, and 373 for radical radiotherapy, if all treated proportions were the same as in the highest quintiles. At the 6 month time-point, 318 deaths per year could be postponed if chemotherapy use for all patients was as in the highest quintile. The results were robust to statistical adjustments for age, sex, socio-economic status, performance status and co-morbidity.Conclusion: The extent of use of different treatment modalities varies between geographical areas in England. These variations are not attributable to measurable patient and tumour characteristics, and more likely reflect differences in clinical management between local multi-disciplinary teams. The data suggest improvement over time, but there is potential for further survival gains if the use of active treatments in all areas could be increased towards the highest current regional rates. [ABSTRACT FROM AUTHOR]

Aim of database: The Danish Lung Cancer Registry (DLCR) was established by the Danish Lung Cancer Group. The primary and first goal of the DLCR was to improve survival and the overall clinical management of Danish lung cancer patients. Study population: All Danish primary lung cancer patients since 2000 are included into the registry and the database today contains information on more than 50,000 cases of lung cancer. Main variables: The database contains information on patient characteristics such as age, sex, diagnostic procedures, histology, tumor stage, lung function, performance, comorbidities, type of surgery, and/or oncological treatment and complications. Since November 2013, DLCR data on Patient -Reported Outcome Measures is also included. Descriptive data: Results are primarily reported as quality indicators, which are published online monthly, and in an annual report where the results are commented for local, regional, and national audits. Indicator results are supported by descriptive reports with details on diagnostics and treatment. Conclusion: DLCR has since its creation been used to improve the quality of treatment of lung cancer in Denmark and it is increasingly used as a source for research regarding lung cancer in Denmark and in comparisons with other countries. [ABSTRACT FROM AUTHOR]

BackgroundIn the 1990s outcomes in Danish lung cancer patients were poor compared with the other Nordic countries. The five-year survival was only about 5%, only 10% of patients were operated on and less than 60% received active surgical or oncologic treatment. This paper describes trends in mortality and survival of lung cancer in Denmark from 2000 to 2012. MethodsThe study population comprised 52 435 patients with a diagnosis of cancer of the trachea and the lung, primarily ascertained from the Danish Lung Cancer Register and grouped into three cohorts by year of diagnosis. The outcome measures covered the first year as well as the first full five-year period after diagnosis and comprised absolute mortality rate (per 100 patient years), absolute survival, and the relative survival. All outcomes were estimated for the overall patient population as well as after stratification by covariates. ResultsOverall, the mortality rates have declined significantly over time from 117 per 100 patient years to 88 for the one-year mortality and from 75 to 65 for the five-year mortality rates, respectively. With the exception of patients with advanced stage, declining mortality was observed for all strata by gender, comorbidity, stage and surgery status and was accompanied by corresponding improvements in both absolute and relative survival. ConclusionsThe mortality has been significantly declining and the prognosis correspondingly improving in lung cancer in Denmark since the turn of the millennium. As of today, survival after lung cancer in Denmark is probably in line with the international standard. Based on our results we recommend introducing mortality indicators based on all-cause mortality within the patient population in international benchmarking studies as comparisons based on cancer-specific mortality relative to the total general population may be misleading when interpreted in the context of outcomes and quality of care. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: The study has been performed to investigate the mortality within the first year after resection in patients with primary lung cancer, together with associated prognostic factors including gender, age, tumour stage, comorbidity, alcohol abuse, type of surgery and post-surgical complications. METHODS: All patients (n = 3363) from the nationwide Danish Lung Cancer Registry with first resection performed between 1 January 2007 and 31 December 2011 were analysed by Kaplan–Meier techniques and Cox-regression analysis concerning death within the first year after resection. Covariates included gender, age, comorbidity (Charlson comorbidity index), perioperative stage, type of resection, registered complications to surgery and alcohol abuse. RESULTS: The cumulative deaths after 30 days, 90 days, 180 days and 360 days were 72 (2.1%), 154 (4.6%), 239 (7.1%) and 478 (14.2%), respectively. Low stage, female gender, young age, no comorbidity, no postoperative complications, no alcohol abuse and lobectomy as type of resection were favourable for survival. CONCLUSIONS: Our results demonstrate that resection in primary lung cancer impacts mortality far beyond the initial 30 days after resection, which is conventionally considered a time window of relevance for the adverse outcome of surgery. Increased efforts should be made for optimizing the selection of patients suited for resection and for identifying patients at increased risk of death after resection. Furthermore, patients should be monitored more closely and more frequently, in particular those patients with high risk of death after resection. [ABSTRACT FROM AUTHOR]

Background. To address social inequality in survival after lung cancer, it is important to consider how socioeconomic position (SEP) influences prognosis. We investigated whether SEP influenced receipt of first-line treatment and whether socioeconomic differences in survival could be explained by differences in stage, treatment and comorbidity. Material and methods. In the Danish Lung Cancer Register, we identified 13 045 patients with lung cancer diagnosed in 2004-2010, with information on stage, histology, performance status and first-line treatment. We obtained age, gender, vital status, comorbid conditions and socioeconomic information (education, income and cohabitation status) from nationwide population-based registers. Associations between SEP and receipt of first-line treatment were analysed in multivariate logistic regression models and those with overall mortality in Cox regression models with stepwise inclusion of possible mediators. Results. For both low- and high-stage lung cancer, adjusted ORs for first-line treatment were reduced in patients with short education and low income, although the OR for education did not reach statistical significance in men with high-stage disease. Patients with high-stage disease who lived alone were less likely to receive first-line treatment. The socioeconomic difference in overall survival was partly explained by differences in stage, treatment and comorbidity, although some differences remained after adjustment. Among patients with high-stage disease, the hazard ratio (HR) for death of those with low income was 1.12 (95% CI 1.05-1.19) in comparison with those with high income. Among patients with low-stage disease, those who lived alone had a 14% higher risk for dying (95% CI 1.05-1.25) than those who lived with a partner. The differences in risk for death by SEP were greatest in the first six months after diagnosis. Conclusion. Socioeconomic differences in survival after lung cancer are partly explained by social inequality in stage, first-line treatment and comorbidity. Efforts should be made to improve early diagnosis and adherence to first-line treatment recommendations among disadvantaged lung cancer patients. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To quantify the effect of comorbidity on stage-specific survival in resected non-small cell lung cancer (NSCLC) patients. Methods: From the Danish Lung Cancer Registry, 20,461 patients diagnosed with lung cancer between 1st January 2005 and 31st December 2010 were identified. Among 3152 NSCLC patients who underwent surgical resection, mortality hazard ratios were calculated during three consecutive time periods following surgery (0–1month, 1month–1year and >1year) according to Charlson comorbidity score (CCS 0, 1, 2, 3+), Eastern Cooperative Oncology Group (ECOG) performance status, lung function, age, sex, pathological T (pT) and N (pN) stage using Cox proportional hazard modelling. The Kaplan Meier method was used to describe stage-specific survival according to the CCS. Results: Severe comorbidity (CCS 3+) was independently associated with significantly higher death rates throughout the three periods of follow-up [Hazard ratio (HR) 2.06 (1.13–3.75) for CCS 3+ in 0–1month, 1.57 (1.17–2.12) 3+ during1month–1year and 1.84 (1.42–2.37) after 1year]. Stage-specific 5-year survival in patients with severe comorbidity was significantly lower than in patients without comorbid disease [e.g. 38% (95% confidence interval (CI) 23–53%) for pT1 and CCS 3+ versus 69% (62–75%) for pT1 and CCS 0]. Conclusion: Severe comorbidity affects survival of NSCLC patients who undergo surgical resection by as much as a single stage increment and this effect persists throughout follow-up. Further research may be necessary to help identify which patients are most likely to benefit from surgery. [Copyright &y& Elsevier]

Abstract: Aim: To examine possible associations between socioeconomic position and surgical treatment of patients with early-stage non-small-cell lung cancer (NSCLC). Methods: In a register-based clinical cohort study, patients with early-stage (stages I–IIIa) NSCLC were identified in the Danish Lung Cancer Register 2001–2008 (date of diagnosis, histology, stage, and treatment), the Central Population Register (vital status), the Integrated Database for Labour Market Research (socioeconomic position), and the Danish Hospital Discharge Register (comorbidity). Logistic regression analyses were performed overall and separately for stages I, II and IIIa. Results: Of the 5538 eligible patients with stages I–IIIa NSCLC diagnosed 2001–2008, 53% underwent surgery. Higher stage, older age, being female and diagnosis early in the study period were associated with higher odds for not receiving surgery. Low disposable income was associated with greater odds for no surgery in stage I and stage II patients as was living alone for stage I patients. Comorbidity, a short diagnostic interval and small diagnostic volume were all associated with higher odds for not undergoing surgery; but these factors did not appear to explain the association with income or living alone for early-stage NSCLC patients. Conclusion: Early-stage NSCLC patients with low income or who live alone are less likely to undergo surgery than those with a high income or who live with a partner, even after control for possible explanatory factors. Thus, even in a health care system with free, equal access to health services, disadvantaged groups are less likely to receive surgery for lung cancer. [Copyright &y& Elsevier]