According to a study recently published in the Journal of Thoracic Oncology, less than half of English patients from lower socio-economic backgrounds diagnosed with non-small cell lung cancer (NSCLC) were able to access novel anti-cancer therapies despite such therapies being available through the country’s National Health Service (NHS).1
In England, all cancer patients are entitled to free care at the point of delivery within the universal, publicly funded, NHS, including treatment with guideline-approved targeted therapies and immune checkpoint inhibitors. Studies in other countries have shown that lung cancer survival rates are lower in people from lower socio-economic backgrounds. Socio-economic differences can lead to inequalities in the use of conventional treatments such as chemotherapy.2,3,4,5 However, previous research has yet to determine if these inequalities are also observed with newer anti-cancer therapies.
The researchers from the Population Health Sciences Institute at Newcastle University and Newcastle-upon-Tyne Hospital’s NHS Trust conducted a retrospective analysis of all 90,785 patients diagnosed with histologically confirmed stage IV NSCLC between 2012 and 2017, using data from the English national population-based cancer registry and linked Systemic Anti-Cancer Therapy (SACT) database.
Novel anti-cancer therapies examined in the study include molecular targeted therapies targeting either oncogene addiction or synthetic lethality with activity restricted to tumors with appropriate biomarker status; biologic treatments with no predictive biomarker included in the license; and immune checkpoint inhibitors. They examined receipt of novel anti-cancer treatments by patients’ “deprivation category,” which was measured with the Index of Multiple Deprivation—a proxy for socio-economic status. The researchers also accounted for differences among patients in other factors that could affect suitability for treatment, including stage at diagnosis, tumor morphology, comorbidities, and age.
“Patients residing in the most deprived areas were 55% less likely to utilize any of these novel anti-cancer therapies compared to those residents in the least deprived areas,” said lead author Linda Sharp, PhD, who is Professor of Cancer Epidemiology from the Population Health Sciences Institute at Newcastle University. “Overall, these findings suggest that despite significant improvements in NSCLC treatment and prognosis, socioeconomic status is an important factor in access to novel treatment, even within the context of the England’s NHS, where treatment is free at the point of delivery.”
- 1. Norris RP, Dew R, Greystoke A, Todd A, Sharp L. Socio-economic Inequalities in Novel NSCLC Treatments During the Era of Tumor Biomarker Guided Therapy: A Population-based Cohort Study in a Publicly Funded Healthcare System [published online ahead of print, 2023 May 3]. J Thorac Oncol. 2023;S1556-0864(23)00522-1. doi:10.1016/j.jtho.2023.04.018
- 2. Hrubá F, Fabiáová E, Bencko V, Cassidy A, Lissowska J, Mated D et al. Socioeconomic indicators and risk of lung cancer in central and eastern Europe. Cent Eur J Public Health. 2009;17(3):115-121. https://doi.org/10.21101/cejph.a3516
- 3. Forrest LF, Adams J, Wareham H, Rubin G, White M. Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis. PLoS Med. 2013;10(2):e1001376. https://doi.org/10.1371/journal.pmed.1001376
- 4. Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic differences and lung cancer survival – systematic review and meta-analysis. Front Oncol. 2018;8:536. https://doi.org/10.3389/fonc.2018.00536
- 5. Goussault H, Gendarme S, Assié JB, Bylicki O, Chouaïd C. Factors associated with early lung cancer mortality: a systematic review. Expert Rev Anticancer Ther. 2021;21(10):1125-1133. https://doi.org/10.1080/14737140.2021.1941888