Setting the Benchmark: Patterns of Care and Outcomes for Early-stage Non-small Cell Lung Cancer in Queensland, Australia, 2011-2017.

[AIM] Treatment paradigms for early-stage non-small cell lung cancer (NSCLC) are evolving rapidly. Our aim was to document baseline patterns of care and outcomes at the population level immediately prior to the introduction of immunotherapy.

[METHODS] Data were obtained from the Queensland Oncology Repository. The study cohort comprised Queensland residents diagnosed with a non-metastatic primary NSCLC between 2011 and 2017, with follow-up on treatment and mortality to December 31, 2022. Poisson regression was used to determine patient and clinical characteristics associated with receiving different treatment modalities within 1 year of diagnosis. Variations in 5-year observed survival were assessed using flexible parametric modelling.

[RESULTS] A total of 4445 people were included, of whom 30% were treated with surgery only, 15% with surgery plus chemotherapy and/or radiotherapy and 44% with chemotherapy and/or radiotherapy only. The remaining 10% did not receive any recorded treatment. People in outer regional/remote areas had lower rates of radiotherapy (relative likelihood [RL] = 0.87, 95% confidence interval [CI] 0.78-0.97) and chemotherapy (RL = 0.89, 95% CI 0.81-0.98) than those in major cities, but there were no significant differences by First Nations status or socio-economic status. Five-year observed survival varied from 63% (95% CI 60%-65%) for stage I to 41% (38%-45%) for stage II and 20% (18%-22%) for stage III. The treatment modality significantly affected survival irrespective of stage at diagnosis (all p < 0.001).

[CONCLUSION] Monitoring treatment outcomes for early-stage NSCLC at the population level is crucial for optimizing patient care, resource allocation and informing consumer choice. Emerging approaches involving immunotherapy are expected to further improve outcomes.