The main point is the study found that survival rates in England were lower than they were in the U.S. They seem to suggest that the difference seems to be cultural in part. In England people are more likely to wait longer to seek treatment when they have symptoms. This is significant because most cancers are easier to treat and cure if caught early. And in the U.S. people are more likely to receive more aggressive treatment.
Big Difference in Active Treatment
Looking at the proportion of patients who received any active treatment, investigators noted a large differences between the two countries.
In the overall cohort, 46% of English patients vs 60% of US patients received some form of active treatment.
However, when analysis was restricted to patients whose tumors had been pathologically confirmed, the proportion who received any form of active therapy was similar, at 66% for English patients and 69% for their US counterparts.
The same was also true among patients whose tumors had not been pathologically confirmed, wherein 12.1% of patients in England received some form of active treatment compared with 9.6% of those in the United States.
"Larger differences were observed in the receipt of surgery, however," the study authors write. Here, 13% of English patients underwent surgery compared with 20% of those in the United States. Surgical rates for patients with stage I disease followed the same trend, with 52% of patients in England undergoing surgery compared with 60% of US patients.
In addition, slightly over one third of English patients received chemotherapy or radiotherapy compared with 45% of US patients. "The largest differences in receipt of all treatment modalities were observed for stage II patients," the authors observe — with 70% of patients in England receiving treatment vs 83% of those in the United States.
Overall Survival
Overall survival (OS) rates at both 1 and 2 years after diagnosis were also considerably lower in England than in the United States.
At 1 year, 29.2% of patients in England were alive compared with 40.1% of those in the United States. At 2 years, the rates were 17% and 27.1%, respectively.
In both countries, women had better OS rates than men, even though OS rates for women in England were lower than OS rates for women in the United States.
That said, "survival disparity between countries varied according to stage at diagnosis," the investigators point out.
In fact, OS rates at both 1 and 2 years for patients with stage I disease were similar in England and the United States for those with pathologic confirmation as well as for those who received treatment.
In contrast, only about 28% of patients with stage IIIB-IV disease in England were alive at 1 year after any active treatment compared with approximately 39% of their US counterparts.
At 2 years, OS rates were approximately 12% and 21% for the same-staged cohort in England and the United States, respectively.
Investigators also analyzed a random sample of 1000 patients in each country who had pathologic confirmation of their tumor.
Two years from their diagnosis, researchers calculated that there were 98 excess deaths for every 1000 patients in England compared with the United States.
This number would decrease to 54 excess deaths per 1000 patients if stage distribution at diagnosis were taken into account and would further decrease to 36 excess deaths per 1000 patients if the 2-year, stage-specific relative survival were the same in England as in the United States.
"The US health system — and to a degree, our culture — is framed around how to best facilitate access to treatment even if the treatment may not necessarily be helpful," Gross observed.
"But erring on the side of facilitating access can also ensure access to beneficial therapies," he added.
As Gross noted, stage distribution will be particularly important to track in the future as lung cancer screening is being introduced in both countries; screening will increase probably diagnosis at an earlier stage of disease.
