Lung Cancer Treatment Disparities in China: A Question in Need of an Answer

• Published in: The oncologist (Dayton, Ohio) Vol. 19; no. 10; pp. 1084 - 1090
• Main Authors: Yang, Lu‐Lu, Zhang, Xu‐Chao, Yang, Xue‐Ning, Yang, Jin‐Ji, Wang, Zhen, Chen, Hua‐Jun, Yan, Hong‐Hong, Xu, Chong‐Rui, Guan, Ji‐Lin, He, Yan‐Yan, Zhong, Wen‐Zhao, An, She‐Juan, Wu, Yi‐Long
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.10.2014
• Subjects: Age Factors; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy; China - epidemiology; Global Health and Cancer; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Humans; Lung cancer; Lung Neoplasms - epidemiology; Lung Neoplasms - therapy; People's Republic of China; Protein Kinase Inhibitors - therapeutic use; Receptor, Epidermal Growth Factor - antagonists & inhibitors; Retrospective Studies; Treatment disparity; China; People’s Republic of China; Retrospective studies; Treatment disparity; Lung cancer
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2014-0007

Background. Substantial progress has been made in the treatment of malignancies in the People's Republic of China in recent years. The goal of this study was to identify the extent to which national treatment guidelines are being used to customize patient care in lung cancer and to analyze the reasons for treatment disparities. Methods. Patient characteristics and treatments were investigated retrospectively for the period from October 2004 to January 2013 using the outpatient database of the Guangdong Lung Cancer Institute (GLCI) in China. Results. A total of 2,535 outpatients with lung cancer were studied in this retrospective analysis. The treatment disparity was 45.3%. Overall, 20.6% of patients with stage I non‐small cell lung cancer (NSCLC) were overtreated, and 20.1% of stage II patients were undertreated. Only 19.6% of stage IIIA patients and 30.7% of stage IIIB patients underwent the recommended combination of chemotherapy and radiotherapy, respectively. For advanced NSCLC, the greatest treatment disparity appeared in the second‐line setting and beyond. Patients who were positive for epidermal growth factor receptor (EGFR) and receiving EGFR tyrosine kinase inhibitors experienced significant prolongation of survival compared with patients who were EGFR negative or whose EGFR mutation status was unknown (hazard ratio: 0.79; p = .037). The treatment disparities were significantly larger among patients aged younger than 65 years and in patients from developing regions compared with patients aged 65 years and older and from developed regions, respectively (p < .001, p = .046). The difference in treatment disparity was statistically significant between GLCI and other hospitals (p < .001). Conclusion. This retrospective study of a large number of patients from an outpatient oncology database demonstrated large disparities in the treatment of lung cancer in China. It is important to develop a new guideline for recommendations that are based on resource classification. 摘要 背景. 近年来中国大陆在恶性肿瘤治疗方面已经取得了重大进展。本研究旨在明确国家级肺癌治疗指南在患者治疗方案制定中的应用程度，并分析产生治疗差异的原因。 方法. 采用中国广东省肺癌研究所（GLCI）门诊数据库2004年10月∼2013年1月的数据，对患者基线特征和治疗进行了回顾性研究。 结果. 本回顾性分析共纳入2 535例门诊肺癌患者。45.3%的患者的治疗方案与指南存在差异。总体上，20.6%的I期非小细胞肺癌（NSCLC）患者治疗过度，20.1%的II期患者治疗不足。只有19.6%的IIIA期患者和30.7%的IIIB期患者接受了指南建议的联合放化疗方案。就晚期NSCLC患者而言，最大的差异来自二线及后续治疗。与表皮生长因子受体（EGFR）阴性或EGFR突变状态不明的患者相比，EGFR阳性并接受EGFR酪氨酸激酶抑制剂治疗的患者生存期显著延长（风险比：0.79，P = 0.037）。< 65岁患者与≥ 65岁患者之间，以及发展中地区患者与发达地区患者之间，都存在较大的治疗差异（分别为P < 0.001和P = 0.046。GLCI和其他医院之间的治疗差异也有统计学意义（P < 0.001）。 结论. 本项大型回顾性研究的患者数据来自门诊肿瘤数据库，证实了中国肺癌的治疗与国家级指南之间还存在重大差异。根据不同地区的资源条件制订新的推荐指南至关重要。The Oncologist 2014;19:1084‐1090 The goal of this study was to identify the extent to which national treatment guidelines are being used in the People's Republic of China to customize patient care in lung cancer and to analyze the reasons for treatment disparities. The results demonstrated large disparities in the treatment of lung cancer in China