Observations in lung cancer over multiple decades: an analysis of outcomes and cost at a single high-volume institution.
OBJECTIVE
This study reviews survival outcomes and cost of lung cancer care over multiple decades at a single high-volume institution.


METHODS
All patients with a diagnosis of lung cancer were analysed at a single institution from 1959 to 2010. Data were extracted from a tumour registry, which was linked to a longitudinal medical record, clinical data repository and social security master death index. In-depth survival analyses by stage were performed using Kaplan-Meier methods from 1981 to 2010. The analysis contains hospital billing data on 1025 lung cancer patients from 2004 to 2010.


RESULTS
A total of 17 025 patients with lung cancer were identified over the study period. The 1-year, 5-year and 10-year all-cause mortality rates were 41, 78 and 87%, respectively. Non-small-cell lung cancer comprised 73% (n = 12 361) of cases where the median survival = 2.5 years and the population was 94% Caucasian. Lung cancer was most prevalent between ages 60-79 years of life. Female gender and adenocarcinoma were increasingly more prevalent over the decades. The 5-, 10- and 15-year survival for non-small-cell lung cancer (NSCLC) patients were 27, 15 and 5%, respectively. Death rates measured at 1 year after diagnosis were reduced; however, 5-year survival over each subsequent decade did not significantly change. In patients where the full scope of cost data were available, the median cost/patient with any stage NSCLC = $40 500, where 63% of the cost is expended in the first year after diagnosis. The average length of treatment for NSCLC was 20.2 months. The greatest single category of expense was chemotherapy (31%), followed by surgery (24%), inpatient medical (17%), radiation therapy (12%) and diagnostics (5%). For surgically treated patients, Stage II-IV costs were roughly twice those of Stage I.


CONCLUSIONS
There has been no evident improvement over the past 3 decades in 5-year survival (∼27%) in patients diagnosed with NSCLC at a single high-volume institution. Improvement in 1-year survival is thought to be attributed to improvements in diagnosing lung cancer earlier. Most of the healthcare expenditure for lung cancer is incurred during the first year after diagnosis despite stage.
Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA mlanuti@partners.org.
Michael
M
Lanuti
Laboratory for Quantitative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Hyo-Jung
HJ
Hong
Laboratory for Quantitative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Shihab
S
Ali
Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Cameron
C
Stock
Division of Hematology/Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Jennifer
J
Temel
Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Douglas
D
Mathisen
Laboratory for Quantitative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
James S
JS
Michaelson
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
Cost; Lung cancer; Survival analysis; Time trends