IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden.
IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden; Karolinska Institutet, Solnavägen 1, SE-17177, Solna, Sweden.
J Cancer Policy. 2022 Dec;34:100362. doi: 10.1016/j.jcpo.2022.100362. Epub 2022 Sep 7.
Systemic anti-cancer therapy (SACT) is the recommended treatment modality in patients with advanced non-small cell lung cancer (aNSCLC) in clinical guidelines. SACT options in aNSCLC have multiplied in recent years with the introduction of immunotherapy and targeted therapy. This article presents findings from the first comparative analysis of SACT patterns in Europe.
SACT rates in aNSCLC were estimated as the ratio between the number of patients treated with SACT (chemotherapy, immunotherapy, targeted therapy) and the number of potentially eligible patients for SACT in 11 countries (Belgium, Bulgaria, Finland, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Romania, UK) between 2014 and 2020. Treated patients were estimated by combining national sales volume data of cancer drugs and average drug use per patient based on clinical trials. Potentially eligible patients were estimated from national epidemiological data.
SACT rates in aNSCLC differed greatly, ranging from around 30 % in Hungary, Poland, and the UK to almost 60 % in Ireland, Norway, and Portugal in 2014. SACT rates seemed to increase over time in most countries, but differences were still large by 2020, ranging from around 40 % in the UK to 75 % or more in Belgium, Norway, and Portugal. Even in countries with the highest SACT rates, far from all patients seemed to receive guideline-recommended SACT options, as underuse of immunotherapy and targeted therapy was common.
Up to 35 % of eligible patients with aNSCLC receives no SACT in certain European countries, although improvements have been achieved over time. The use of immunotherapy and targeted therapy is suboptimal even in countries with high SACT rates, indicating room to improve the quality of care and patient outcomes.
Measuring if and what kind of therapy cancer patients have access to is vital to assess quality of care. The care of aNSCLC patients seems to be suboptimal in Europe, due to factors such as exclusion of patients with moderate performance status from SACT, limited resources for diagnostic testing, long reimbursement timelines and slow adoption of new medicines in clinical practice.
临床指南建议对晚期非小细胞肺癌（aNSCLC）患者采用全身性抗癌治疗（SACT）。近年来，随着免疫疗法和靶向疗法的引入，aNSCLC 的 SACT 选择方案成倍增加。本文介绍了欧洲首次对 SACT 模式进行比较分析的结果。
2014 年至 2020 年，在 11 个国家（比利时、保加利亚、芬兰、匈牙利、爱尔兰、荷兰、挪威、波兰、葡萄牙、罗马尼亚、英国）中，通过比较接受 SACT（化疗、免疫疗法、靶向疗法）治疗的患者人数与可能适合 SACT 的患者人数，估算 aNSCLC 中的 SACT 率。通过结合癌症药物的国家销售数据和临床试验中每位患者的平均药物使用量，估算接受治疗的患者人数。通过国家流行病学数据估算可能适合的患者人数。
2014 年，aNSCLC 的 SACT 率差异很大，匈牙利、波兰和英国的 SACT 率约为 30%，爱尔兰、挪威和葡萄牙的 SACT 率接近 60%。大多数国家的 SACT 率似乎随时间而增加，但到 2020 年差异仍然很大，英国的 SACT 率约为 40%，而比利时、挪威和葡萄牙的 SACT 率则为 75%或更高。即使在 SACT 率最高的国家，也远非所有患者都接受了指南推荐的 SACT 方案，因为免疫疗法和靶向疗法的使用不足很常见。
在某些欧洲国家，多达 35%的符合条件的 aNSCLC 患者未接受任何 SACT，尽管随着时间的推移，这一情况有所改善。即使在 SACT 率较高的国家，免疫疗法和靶向疗法的使用也不理想，这表明在提高护理质量和患者预后方面还有改进的空间。
衡量癌症患者是否能够获得何种治疗方法对于评估护理质量至关重要。由于某些因素，如将体力状况中等的患者排除在 SACT 之外、诊断检测资源有限、报销时间长以及新药物在临床实践中采用缓慢等，欧洲的 aNSCLC 患者的护理似乎并不理想。
