New cancer treatments were not available to more than half of patients in England diagnosed with non-small cell lung cancer, according to a new study published in the journal Journal of Thoracic Oncologyofficial journal of the International Association for Lung Cancer Research.
In England, all cancer patients are entitled to free care at the point of delivery under the universal publicly funded National Health Service (NHS), including treatment with guideline-approved targeted therapies and immune checkpoint inhibitors. Private healthcare, especially for diseases such as cancer, is rare.
New cancer therapies include molecularly targeted therapies targeting oncogene addiction or synthetic lethality with activity restricted to tumors with appropriate biomarker status (e.g. simertinib); a biological treatment without a licensed prognostic biomarker (e.g. bevacizumab); and immune checkpoint inhibitors (ICIs), which use the immune system to recognize and attack cancer cells (e.g., pembrolizumab).
Studies in many countries show that lung cancer survival rates are lower in people from lower socioeconomic backgrounds. One reason may be socio-economic differences in access to treatment. Previous studies have shown socioeconomic inequities in the use of conventional NSCLC treatments such as chemotherapy, but it is not known whether these inequalities are also observed with new cancer therapies.
To assess this, researchers from the Population Health Sciences Institute at Newcastle University and Newcastle-upon-Tyne Hospitals 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 English National Population based Cancer Registry and related Systemic Anti-Cancer Therapy (SACT) database.
Researchers examined the intake of new cancer treatments by the deprivation category of patients in the place of residence at the time of diagnosis, as measured by the quintile rank of the income domain of the Multiple Deprivation Index (IMD – a widely used approximation of socioeconomic status). They accounted for differences between patients in other factors that may determine suitability for treatment, such as stage at diagnosis, tumor morphology, comorbidities, and age.
Patients living in the most deprived areas were 55% less likely to receive any of these novel cancer treatments than those living in the least deprived areas. Overall, these findings suggest that despite significant improvements in NSCLC treatment and prognosis, socioeconomic status is an important factor in accessing new treatment, even in the UK NHS context, where treatment is free at the point of delivery.”
Dr Linda Sharp, lead author, professor of cancer epidemiology at the Institute of Population Health Sciences, Newcastle University
Co-author Dr Adam Todd, Professor of Pharmaceutical Public Health added: “There is an urgent need to investigate the causes of these inequalities so that we can take steps to eliminate them. This is essential if we are to realize the full potential of these therapies for NSCLC patients.
Norris, R.P., et al. (2023) Socioeconomic Inequities in New NSCLC Treatments in the Era of Cancer Biomarker-Driven Therapy: A Population-Based Cohort Study in a Publicly Funded Health System. Journal of Thoracic Oncology. doi.org/10.1016/j.jtho.2023.04.018.