New anti-cancer therapies have been out of reach for 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 TumorsOfficial journal of the International Association for the Study of Lung Cancer.
In England, all cancer patients are entitled to free care at the point of delivery under the comprehensive, government-funded National Health Service (NHS), including treatment with guideline-approved targeted therapies and immune checkpoint inhibitors. Private healthcare, especially for conditions such as cancer, is uncommon.
Novel anticancer therapies include targeted molecular therapies that target either oncogene addiction or synthetic killers with activity limited to tumors with appropriate biomarker status (eg, simertinib); Biological therapies that do not have predictive biomarkers included in the license (eg, bevacizumab); and immune checkpoint inhibitors (ICIs) that use the immune system to recognize and attack cancer cells (such as pembrolizumab).
Studies in many countries show that lung cancer survival rates are lower in people from lower socioeconomic backgrounds. One reason for this may be socioeconomic differences in accessing treatment. Previous research has shown socioeconomic inequalities in the use of conventional NSCLC therapies such as chemotherapy, but it is not known whether these inequalities are also observed with newer anticancer therapies.
To assess this, researchers from Newcastle University’s Institute of Population Health Sciences and Newcastle Upon Tyne Hospitals NHS Trust carried out 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. – The approved Cancer Registry and Systemic Anti-Cancer Therapy (SACT) database.
The researchers examined receipt of new anticancer therapies by the deprivation category of patients in the area of residence at diagnosis as measured using the income domain quintile of the Index of Multiple Deprivation (IMD – a widely used proxy for socioeconomic status). They took into account patients’ differences in other factors that could determine the appropriateness of treatment, such as stage at diagnosis, tumor morphology, comorbidities, and age.
Patients residing in the most deprived areas were 55% less likely to have used any of these new anti-cancer therapies than those residing in the least deprived areas. Overall, these results suggest that despite significant improvements in the treatment and prognosis of NSCLC, socioeconomic status is an important factor in accessing a new treatment, even in the context of the NHS in England, where treatment is free on delivery.”
Linda Sharp, PhD, lead author, is Professor of Cancer Epidemiology from the Institute of Population Health Sciences at Newcastle University
Co-author Adam Todd, Professor of Pharmaceutical Public Health, added, “There is an urgent need to investigate the causes of these disparities 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, RP, et al. (2023) Socioeconomic disparities in novel NSCLC therapies during an era of targeted therapy for tumor biomarkers: a population-based cohort study in a publicly funded healthcare system.. Journal of Thoracic Tumors. doi.org/10.1016/j.jtho.2023.04.018.