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NSCLC Patients in Poorer Areas Don't Receive Newest Treatments

Editor's note: Quotes were added to this article from Cancer Research UK

More than half of English patients with non-small cell lung cancer (NSCLC) in areas of high socio-economic deprivation do not receive new anti-cancer therapies, said researchers. 

In the last two decades, an improved understanding of tumour heterogeneity, identification of novel biomarkers, and the development of novel anti-cancer therapies, had changed clinical practice in oncology, said the authors of a new study published in the Journal of Thoracic Oncology as a journal pre-print, prior to review.

The authors emphasised that in England, "all cancer patients are entitled to care, free at the point of delivery within the universal, publicly funded, National Health Service (NHS)". This included treatment with guideline-approved targeted therapies and immune checkpoint inhibitors.

They explained that lung cancer survival rates had been shown in studies to be lower in people from lower socio-economic backgrounds, and that research had demonstrated socio-economic inequalities in the utilisation of conventional NSCLC treatments, such as chemotherapy. However, it remained unknown if these inequalities were also observed with novel anti-cancer therapies.

Significant and Consistent Inequalities

For the study, researchers from the Population Health Sciences Institute at Newcastle University and Newcastle-upon-Tyne Hospitals NHS Trust conducted a retrospective analysis of 90,785 patients diagnosed with histologically confirmed stage IV NSCLC between 1 January 2012 and 31 December 2017. Their data was sourced from the English national population-based cancer registry-linked systemic anti-cancer therapy database. Most patients (83.3%) were aged between 60-89 years and most were of white ethnicity (91.9%).

The researchers' aim was to examine associations between deprivation and utilisation of novel anti-cancer therapies targeting tumour biology and/or the immune system within the English NHS.

They investigated receipt of novel anti-cancer treatments by patients' deprivation category for their area of residence at diagnosis and accounted for differences between patients – such as stage at diagnosis, tumour morphology, comorbidities, and age – that could determine suitability for treatment.

Overall, 7.2% of stage IV NSCLC patients utilised a novel anti-cancer therapy from 2012 to 2017. Utilisation was slightly higher in females than in males (8.4% versus 6.2%). The researchers identified that utilisation decreased with age (20.4% in the <50 age group vs 0.61% in the 90+ age group) and was associated with a non-white ethnicity (16.4% in the non-white population vs 7.0% in the white population).

Treatment Inequalities by Deprivation Observed

"Significant and consistent inequalities in novel treatment utilisation were observed with consistent trends of decreasing odds of utilisation with increasing deprivation," highlighted the authors. 

Specifically, multivariable analyses revealed that patients residing in the most deprived areas were less than half as likely to utilise any novel therapy (multivariable odds ratio 0.45) compared with patients residing in the most affluent areas. 

"Patients residing in the most deprived areas were 55% less likely to utilise any of these novel anti-cancer therapies compared to those residents in the least deprived areas", pointed out Linda Sharp, PhD, professor of cancer epidemiology at the Population Health Sciences Institute at Newcastle University and lead author.

Inequalities in treatment utilisation were observed across "all drug classes", highlighted the authors, with the most deprived 61%, 53%, and 42% less likely to utilise targeted treatments, biologicals, and immune checkpoint inhibitors, respectively.

Socio-Economic Inequalities a Systemic Issue

There were "marked socio-economic inequalities" in NSCLC novel treatment utilisation, even in the English NHS where treatment is free at the point of delivery, alerted the authors. "The consistency of findings indicate that socio-economic inequalities are a systemic issue in NSCLC," they warned.

"Overall, these findings suggest that, despite significant improvements in NSCLC treatment and prognosis, socioeconomic status is an important factor in access to novel treatment," said Prof Sharp.

Co-author Adam Todd, PhD, professor of pharmaceutical public health, stressed that there was an "urgent need" to investigate the reasons for these inequalities "so we can take steps to eliminate them".

"This is essential if we want to realise the full potential of these therapies for NSCLC patients," he said.

Asked to comment for Medscape News UK , Dr Lyndsy Ambler, senior strategic evidence manager at Cancer Research UK, said: "This paper sadly reinforces existing evidence that those from more deprived areas in England are more likely to face inequalities when it comes to cancer care."

She emphasised that, although data availability and quality made it "tricky" to identify what was driving this variation, "that doesn't mean action can't be taken".

"Every person should have the best chances of surviving their cancer, regardless of their socioeconomic background," said Dr Ambler.

Funding was provided by Barbour Foundation and Cancer Research UK. AG reported consultancy and speaker fees from Bayer, Roche, Amgen, Janssen, Merck, AstraZeneca, Pfizer, and Takeda, as well as meeting and travel support from Roche, Janssen, and Takeda and a leadership role at the Northeast England Yorkshire and Humber genomics laboratory hub, all outside the submitted work. AT reports royalties from Wiley publishers outside the submitted work. The remaining authors declared no conflict of interest.