title: Changing trends in diagnosis, staging, treatment and survival in lung cancer: comparison of three consecutive cohorts in an Australian lung cancer centre.
abstract: BACKGROUND
  Lung cancer accounts for significant morbidity and mortality worldwide. The effect of recent changes in demographics and management on outcomes in Australia has not been clearly defined.
  
  
  OBJECTIVE
  To compare three consecutive lung cancer cohorts to evaluate emergent differences in diagnosis, management and mortality.
  
  
  METHODS
  For comparative analysis, 2119 lung cancer patients were divided into three successive cohorts. Current death data were sought from the Victorian Cancer Registry.
  
  
  RESULTS
  Age at diagnosis, mode of presentation and pathology did not significantly differ between the groups. Significantly more females were diagnosed with lung cancer in the most recent cohort (P = 0.04). Amongst non-small-cell lung cancer patients, there were more adenocarcinomas and less large cell carcinomas in the latest cohort (P = <0.01). More patients from the most recent cohort were staged pathologically and via positron emission tomography and fewer were clinically staged (P = <0.01). The most recent cohort had a greater proportion of Stage IV disease (P = <0.01) and more curative surgical or combined modality radiotherapy and chemotherapy versus palliative radiotherapy or supportive care (P = <0.01). Overall 5-year survival improved significantly in the most recent cohort, even after adjustment for age, gender and stage (P = <0.01).
  
  
  CONCLUSIONS
  Comparison of three lung cancer patient cohorts diagnosed between 2001 and 2013 highlights emergent changes in lung cancer demographics, management and outcomes. These include recent increases in proportion of females, pathological and positron emission tomography staging, and Stage IV disease, as well as improved survival despite later stage disease.
authors.affiliation: Department of Respiratory and Sleep Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: E J
authors.identifier: http://orcid.org/0000-0003-1482-7626
authors.initials: EJ
authors.lastname: Denton
authors.affiliation: Department of Respiratory and Sleep Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Hart
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Wainer
authors.affiliation: Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Wright
authors.affiliation: Department of Anatomical Pathology, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: P A
authors.initials: PA
authors.lastname: Russell
authors.affiliation: Department of Respiratory and Sleep Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Conron
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012042:Registries; D016019:Survival Analysis
keywords: epidemiology; lung neoplasms; survival; thoracic malignancy