title: Progress in standard of care therapy and modest survival benefits in the treatment of non-small cell lung cancer patients in the Netherlands in the last 20 years.
abstract: BACKGROUND
  Lung cancer is the leading cause of cancer mortality worldwide. We analyzed changes in treatment and their potential effect on survival of non-small cell lung cancer (NSCLC) patients in the Netherlands.
  
  
  METHODS
  All NSCLC patients diagnosed during 1989-2009 (n=147,760) were selected from the population-based Netherlands Cancer Registry. Differences in treatment over time were tested by the Cochran-Armitage trend test. The effects of sex, age, histology, and treatment on relative survival were estimated in multivariable models. Follow-up was completed until January 1, 2010.
  
  
  RESULTS
  Between 1989 and 2009, the proportion of younger patients (younger than 75 years) with stage I undergoing surgery increased from 84 to 89% and among elderly (75 years or elder) from 35 to 49%; for stage II, this proportion decreased from 80 to 70% and remained about 25% in respectively younger and older patients. Adjuvant chemotherapy for stage II increased to from 0 to 24% in younger patients but remained less than 5% among the elderly. Chemoradiation increased from 8 to 43% among younger patients with stage III and from 1 to 13% among elderly. In stage IV, chemotherapy in younger patients increased from 10 to 54% and in elderly from 5 to 21%. Five-year relative survival of the total group increased from 14.8 to 17% (especially among females, younger patients, and within each stage), which could be partly explained by changes in treatment and better staging.
  
  
  CONCLUSIONS
  Over a 20-year period, application of therapy, which is currently considered as standard, has improved. This resulted in small improvements in survival within all stages.
authors.affiliation: Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.vanderdrift@uccz.umcn.nl
authors.forename: Miep A
authors.initials: MA
authors.lastname: van der Drift
authors.forename: Henrike E
authors.initials: HE
authors.lastname: Karim-Kos
authors.forename: Sabine
authors.initials: S
authors.lastname: Siesling
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Coebergh
authors.forename: Esther
authors.initials: E
authors.lastname: de Vries
authors.forename: Maryska L G
authors.initials: ML
authors.lastname: Janssen-Heijnen
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D018287:Carcinoma, Large Cell / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D012737:Sex Factors; D059039:Standard of Care; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome