The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012

Anita Andreano, Mick Peake, Samuel M. Janes, Maria Grazia Valsecchi, Kathy Pritchard-Jones, Jessica R. Hoag, Cary P. Gross*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Introduction: Although prior research has demonstrated lower lung cancer survival in England than in the United States, more detailed comparisons are needed. We conducted a population-based analysis to compare diagnostic, treatment, and survival patterns. Methods: Data from cancer registries and administrative databases were linked for older patients with a diagnosis of NSCLC in England and the United States (2008–2012). We compared patient and clinical characteristics, as well as the distribution of age-standardized receipt of treatment by stage. We compared relative survival overall by stage and treatment. Finally, we assessed the degree to which stage distribution and stage-specific survival contributed to survival differences. Results: Among patients age 66 years or older with a diagnosis of NSCLC in England (n = 86,978) and the United States (n = 84,415), the rate of pathological confirmation was 63% in England compared with 85% in the United States (a 22.2% difference [99% confidence interval: 22.8%–21.7%]). The rate of receipt of active treatment was lower in England than in the United States (46% versus 60%, for a difference of 14.0% [99% confidence interval: 13.3%–14.7%]). In England, we identified 98 excess deaths per 1000 patients with pathologically confirmed NSCLC; these additional deaths could be partially mitigated by adjusting stage at diagnosis (reduction to 54 excess deaths) or stage-specific survival (reduction to 36 excess deaths). Conclusions: Compared with patients with NSCLC in the United States, patients with NSCLC in England are less likely to present with early-stage disease and receive treatment and are more likely to die. Future work should explore whether the intensity of resources directed to diagnostic and therapeutic activity may help mitigate disparities in outcomes.

Original languageEnglish
Pages (from-to)904-914
Number of pages11
JournalJournal of Thoracic Oncology
Issue number7
Publication statusPublished - Jul 2018

Bibliographical note

Funding Information:
Internal funding from each participating center was used to support this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding Information:
Disclosure: Dr. Gross received research funding from 21st Century Oncology LLC and has also received research funding from the National Comprehensive Cancer Network–Pfizer and from Johnson & Johnson to help develop new approaches for sharing clinical trial data sharing. Dr. Pritchard-Jones was supported by NHS England national cancer vanguard funding that supports the Centre for Cancer Outcomes in the UCLH Cancer Collaborative. Dr Janes is a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA) and is supported by Rosetrees Trust, the Roy Castle Lung Cancer Foundation, the Welton Trust, the Garfield Weston Trust, and University College London Hospitals Charitable Foundation. The remaining authors declare no conflict of interest.


  • Cancer therapy
  • Delivery of health care
  • Health services for the aged
  • Lung neoplasms
  • Population registers


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