Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Timeliness and Guideline-Concordant Treatment in Small-Cell Lung Cancer: Factors Influencing Outcomes in Victoria (#19)

Sanuki Tissera 1 , Evangeline Samuel 1 2 , Susan Harden 1 3 , John Zalcberg 1 4 , Rob Stirling 1 5 6 , Wasek Faisal 7 , Baki Billah 1
  1. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  2. Department of Medical Oncology, Latrobe Regional Health, Traralgon, Victoria, Australia
  3. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
  5. Central Clinical School, Monash University, Melbourne, Victoria, Australia
  6. Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
  7. Department of Medical Oncology, Ballarat Regional Integrated Cancer Centre, Ballarat , Victoria, Australia

Aims: This study aims to identify factors causing delays to specialist appointment and treatment for small-cell lung cancer (SCLC) patients and to examine the delivery of guideline-concordant treatment (GCT) to newly diagnosed SCLC patients in Victoria.

Methods: Prospectively collected data from the Victorian Lung Cancer Registry, collected between July-2011 and November-2023 (n=1,769), was analysed. Multivariable logistic regression assessed delays from referral to specialist appointment and diagnosis to treatment, while survival was analysed using Kaplan-Meier estimates and Cox regression.

Results: Patients with extensive stage (ES)-SCLC were more likely to see a specialist within 14 days of referral (84.4%) compared to those with limited stage (LS)-SCLC (74.3%). Diagnosis-to-treatment delays of ≥14 days were more common in LS-SCLC patients (40.24%) than ES-SCLC patients (19.9%). Overall, 43% of SCLC patients received GCT, with higher rates in ES-SCLC (81.9%) compared to LS-SCLC (64.2%). In SCLC patients, referral delays (≥14 days) were more common among in those aged ≥70 years (70 to <80 years HR 2.65 [1.07-6.53] p=0.035, ≥80 years HR 3.62 [1.36-9.61], p=0.010). Diagnosis-to-treatment delays in SCLC patients were associated with respiratory comorbidities (HR 1.40 [1.04-1.87], p=0.026), or treatment at inner-regional hospitals (HR 2.14 [1.40-3.29], p<0.001). Median survival was 1.7 years for LS-SCLC patients, significantly higher than 0.59 years (6 months) for ES-SCLC patients (p<0.001). Receiving any form of treatment was associated with higher survival rates. Patients treated with GCT improved survival by 24% (HR 0.45 [0.32-0.62]) compared to non-GCT (HR 0.21 [0.15-0.30], p<0.001), while discussion at a multidisciplinary meeting was also associated with significantly higher survival (HR 0.84 [0.75-0.96), p=0.007]).

Conclusion: Patients with ES-SCLC were more likely to receive timely specialist appointments and treatment compared to LS-SCLC patients, however, there was no significant difference in survival. Receiving GCT significantly improved survival, highlighting the need to improve GCT adherence for better SCLC outcomes.