title: Small-cell lung cancer in England: trends in survival and chemotherapy using the National Lung Cancer Audit.
abstract: BACKGROUND
  The purpose of this study was to identify trends in survival and chemotherapy use for individuals with small-cell lung cancer (SCLC) in England using the National Lung Cancer Audit (NLCA).
  
  
  METHODS
  We used data from the NLCA database to identify people with histologically proven SCLC from 2004-2011. We calculated the median survival by stage and assessed whether patient characteristics changed over time. We also assessed whether the proportion of patients with records of chemotherapy and/or radiotherapy changed over time.
  
  
  RESULTS
  18,513 patients were diagnosed with SCLC in our cohort. The median survival was 6 months for all patients, 1 year for those with limited stage and 4 months for extensive stage. 69% received chemotherapy and this proportion changed very slightly over time (test for trends p = 0.055). Age and performance status of patients remained stable over the study period, but the proportion of patients staged increased (p-value<0.001), mainly because of improved data completeness. There has been an increase in the proportion of patients that had a record of receiving both chemotherapy and radiotherapy each year (from 19% to 40% in limited and from 9% to 21% in extensive stage from 2004 to 2011). Patients who received chemotherapy with radiotherapy had better survival compared with any other treatment (HR 0.24, 95% CI 0.23-0.25).
  
  
  CONCLUSIONS
  Since 2004, when the NLCA was established, the proportion of patients with SCLC having chemotherapy has remained static. We have found an upward trend in the proportion of patients receiving both chemotherapy and radiotherapy which corresponded to a better survival in this group, but as it only applied for a small proportion of patients, it was not enough to change the overall survival.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Aamir
authors.initials: A
authors.lastname: Khakwani
authors.affiliation: Department of Respiratory Medicine, Nottingham University Hospital, Nottingham, United Kingdom.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Rich
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Laila J
authors.initials: LJ
authors.lastname: Tata
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom ; Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Powell
authors.affiliation: Health and Social Care Information Centre, Leeds, United Kingdom.
authors.forename: Rosamund A
authors.initials: RA
authors.lastname: Stanley
authors.affiliation: Department of Respiratory Medicine, Nottingham University Hospital, Nottingham, United Kingdom.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom ; Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012042:Registries; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate / Q000639:trends