A consensus reached by a lung cancer clinical community within the International Cancer Benchmarking Partnership (ICBP) presented by Lynch et al at the European Lung Cancer Congress (Abstract 196P) has highlighted international disparities in the management and outcomes of patients with lung cancer in high-income countries. The researchers have also provided a roadmap of key actions that should be taken to homogenize practices, help enable earlier diagnosis, and offer equitable access to care.
The ICBP is a collaboration bringing together clinicians, policymakers, researchers, and data experts to measure and understand international variation in cancer incidence and outcomes. For lung cancer, the ICBP SURVMARK-2 project commissioned by the International Agency for Research on Cancer to benchmark cancer survival had previously revealed that variation in survival was greatest in early-stage disease. A research effort subsequently led by the ICBP in-house research team based at Cancer Research UK aimed to gain insight into the differences in clinical practice and treatment that could help explain these disparities between countries.
“We interviewed nine key informants from multidisciplinary teams in ICBP countries. Leveraging a strong network of doctors with both clinical expertise and experience in auditing and policy advisory roles, a consensus-building effort was then launched to develop a roadmap for optimizing lung cancer care from an international perspective,” said first study author Charlotte Lynch, of Cancer Research UK, explaining the process through which 5 calls to action and 13 good practice points were defined reaching 100% consensus.
Calls to Action
The calls to action include the following measures:
(1) Implement cost-effective, clinically efficacious, and equitable lung cancer screening initiatives.
(2) Ensure diagnosis of lung cancer within 30 days of referral.
(3) Develop thoracic centers of excellence.
(4) Undertake an international audit of lung cancer care.
(5) Recognize improvements in lung cancer care and outcomes as a priority in cancer policy.
According to the project’s lead clinician Christian Finley, MD, MPH, of St. Joseph’s Healthcare Hamilton in Ontario, Canada, there is recognition that delayed diagnosis continues to be a widespread problem in a disease setting where the line between curative and noncurative treatment is easily crossed.
“In spite of improvements in other areas like prevention, through smoking cessation initiatives and awareness campaigns, and even treatment, thanks to the arrival of more effective medicines, we have not seen survival in lung cancer improve to the same extent,” Dr. Finley explained, adding: “It is crucial that patients are diagnosed at the earliest point possible to give them the best chance of receiving curative treatment.”
Further recommendations tackle, among others, the need for centers of excellence: “Specialized centers that are able to coordinate multidisciplinary care in a single place and streamline the patient care pathway have been seen to support improvements in outcomes in countries where they have been set up,” said Dr. Finley.
The final call to action defined by consensus is to “Recognize improvements in lung cancer care and outcomes as a priority in cancer policy,” which Ms. Lynch emphasized is a necessity in light of the inequities patients with lung cancer still face in accessing care, including socioeconomic inequalities, fatalistic attitudes, and disease stigma.
“Considering the disease’s persistently low survival even in high-income countries, it is time to focus on lung cancer–specific policies that will facilitate collaboration, drive service development, and improve outcomes to the same extent as we have seen with other common cancers,” she said.
Cautioning that the outlined approach was designed in a high-income setting and therefore cannot be universally applicable, Ms. Lynch nonetheless hopes that it will serve as the basis for conversations with advocacy bodies and policymakers, as well as help key stakeholders within individual countries better coordinate their efforts internationally in the future.
Disclosure: For full disclosures of the study authors, visit oncologypro.esmo.org.
