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Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study

Matthew E Barclay Orcid Logo, Sean McPhail, Shane A Johnson, Ruth Swann, Christian J Finley, John Butler, Riaz Alvi, Andriana Barisic, Damien B Bennett, Oliver Bucher, Nicola Creighton, Cheryl A Denny, Ron A Dewar, David W Donnelly, Jeff J Dowden, Laura Downie, Norah Finn, Steven Habbous, Dyfed Huws, S Eshwar Kumar, Leon May, Carol A McClure, Bjørn Møller, David S Morrison, Grace Musto, Yngvar Nilssen, Nathalie Saint-Jacques Orcid Logo, Sabuj Sarker, Lorraine Shack, Luc te Marvelde Orcid Logo, Xiaoyi Tian, Robert JS Thomas, Catherine S Thomson, Richard Walton, Haiyan Wang, Tommy Hon Ting Wong, Ryan R Woods, Hui You, Bin Zhang, Georgios Lyratzopoulos Orcid Logo

BMJ Oncology, Volume: 4, Issue: 1, Start page: e000800

Swansea University Author: Dyfed Huws

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DOI (Published version): 10.1136/bmjonc-2025-000800

Abstract

Background: International variation in lung cancer survival may be partly explained by variation in stage-specific treatment use, but relevant comparative evidence is sparse. As part of the International Cancer Benchmarking Partnership, we examined use of chemotherapy and radiotherapy in population-...

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Published in: BMJ Oncology
ISSN: 2752-7948
Published: BMJ 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69971
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Methods: Linked population-based data sources were used to describe use and time to first treatment for either chemotherapy or radiotherapy in patients with lung cancer diagnosed in study periods during 2012&#x2013;2017 in 16 jurisdictions of Australia, Canada, the UK and Norway. Results: There was large variation in the proportions of patients with lung cancer receiving chemotherapy (ranging from 23% in Northern Ireland to 45% in Norway) and radiotherapy (ranging from 32% in England to 48% in New South Wales and 50% in Newfoundland and Labrador). Across jurisdictions, chemotherapy use decreased steeply with increasing age, regardless of stage at diagnosis. For radiotherapy use, in stage 1&#x2013;3 cancer three patterns were observed: (a) steep decrease with increasing age (UK jurisdictions, Saskatchewan-Manitoba); (b) a relatively flat pattern (Norway, Alberta, British Columbia, Atlantic Canada, New South Wales) and (c) increasing use with increasing age (Ontario). Time to radiotherapy initiation was longer in the UK jurisdictions than elsewhere; time to chemotherapy was longer in the UK and Canadian jurisdictions except Ontario. Discussion: Use of chemotherapy and radiotherapy in patients with lung cancer varied substantially between jurisdictions during the mid-2010s within age-stage strata. Reasons for these variations are unclear. Differences in non-surgical treatment use are plausibly associated with international variation in lung cancer survival.</abstract><type>Journal Article</type><journal>BMJ Oncology</journal><volume>4</volume><journalNumber>1</journalNumber><paginationStart>e000800</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2752-7948</issnElectronic><keywords>epidemiology, lung cancer (non-small cell), chemotherapy, lung cancer (small-cell), radiotherapy</keywords><publishedDay>11</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-07-11</publishedDate><doi>10.1136/bmjonc-2025-000800</doi><url/><notes/><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm>Other</apcterm><funders/><projectreference/><lastEdited>2025-07-15T12:59:36.3321958</lastEdited><Created>2025-07-15T12:52:43.6995565</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Matthew E</firstname><surname>Barclay</surname><orcid>0000-0003-1148-1922</orcid><order>1</order></author><author><firstname>Sean</firstname><surname>McPhail</surname><order>2</order></author><author><firstname>Shane A</firstname><surname>Johnson</surname><order>3</order></author><author><firstname>Ruth</firstname><surname>Swann</surname><order>4</order></author><author><firstname>Christian J</firstname><surname>Finley</surname><order>5</order></author><author><firstname>John</firstname><surname>Butler</surname><order>6</order></author><author><firstname>Riaz</firstname><surname>Alvi</surname><order>7</order></author><author><firstname>Andriana</firstname><surname>Barisic</surname><order>8</order></author><author><firstname>Damien B</firstname><surname>Bennett</surname><order>9</order></author><author><firstname>Oliver</firstname><surname>Bucher</surname><order>10</order></author><author><firstname>Nicola</firstname><surname>Creighton</surname><order>11</order></author><author><firstname>Cheryl A</firstname><surname>Denny</surname><order>12</order></author><author><firstname>Ron A</firstname><surname>Dewar</surname><order>13</order></author><author><firstname>David W</firstname><surname>Donnelly</surname><order>14</order></author><author><firstname>Jeff J</firstname><surname>Dowden</surname><order>15</order></author><author><firstname>Laura</firstname><surname>Downie</surname><order>16</order></author><author><firstname>Norah</firstname><surname>Finn</surname><order>17</order></author><author><firstname>Steven</firstname><surname>Habbous</surname><order>18</order></author><author><firstname>Dyfed</firstname><surname>Huws</surname><order>19</order></author><author><firstname>S Eshwar</firstname><surname>Kumar</surname><order>20</order></author><author><firstname>Leon</firstname><surname>May</surname><order>21</order></author><author><firstname>Carol A</firstname><surname>McClure</surname><order>22</order></author><author><firstname>Bj&#xF8;rn</firstname><surname>M&#xF8;ller</surname><order>23</order></author><author><firstname>David S</firstname><surname>Morrison</surname><order>24</order></author><author><firstname>Grace</firstname><surname>Musto</surname><order>25</order></author><author><firstname>Yngvar</firstname><surname>Nilssen</surname><order>26</order></author><author><firstname>Nathalie</firstname><surname>Saint-Jacques</surname><orcid>0000-0003-2532-6472</orcid><order>27</order></author><author><firstname>Sabuj</firstname><surname>Sarker</surname><order>28</order></author><author><firstname>Lorraine</firstname><surname>Shack</surname><order>29</order></author><author><firstname>Luc te</firstname><surname>Marvelde</surname><orcid>0000-0002-0082-3299</orcid><order>30</order></author><author><firstname>Xiaoyi</firstname><surname>Tian</surname><order>31</order></author><author><firstname>Robert JS</firstname><surname>Thomas</surname><order>32</order></author><author><firstname>Catherine S</firstname><surname>Thomson</surname><order>33</order></author><author><firstname>Richard</firstname><surname>Walton</surname><order>34</order></author><author><firstname>Haiyan</firstname><surname>Wang</surname><order>35</order></author><author><firstname>Tommy Hon Ting</firstname><surname>Wong</surname><order>36</order></author><author><firstname>Ryan R</firstname><surname>Woods</surname><order>37</order></author><author><firstname>Hui</firstname><surname>You</surname><order>38</order></author><author><firstname>Bin</firstname><surname>Zhang</surname><order>39</order></author><author><firstname>Georgios</firstname><surname>Lyratzopoulos</surname><orcid>0000-0002-2873-7421</orcid><order>40</order></author></authors><documents><document><filename>69971__34770__634cb0b48b214ddbb90a6fce5aa2385d.pdf</filename><originalFilename>bmjonc-2025-000800.pdf</originalFilename><uploaded>2025-07-15T12:52:43.6762818</uploaded><type>Output</type><contentLength>3394316</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Author(s) (or their employer(s)) 2025. 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spelling 2025-07-15T12:59:36.3321958 v2 69971 2025-07-15 Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study d4b1f62e65a55f5ad21c5778c6e03af9 Dyfed Huws Dyfed Huws true false 2025-07-15 Background: International variation in lung cancer survival may be partly explained by variation in stage-specific treatment use, but relevant comparative evidence is sparse. As part of the International Cancer Benchmarking Partnership, we examined use of chemotherapy and radiotherapy in population-based cancer registry data. Methods: Linked population-based data sources were used to describe use and time to first treatment for either chemotherapy or radiotherapy in patients with lung cancer diagnosed in study periods during 2012–2017 in 16 jurisdictions of Australia, Canada, the UK and Norway. Results: There was large variation in the proportions of patients with lung cancer receiving chemotherapy (ranging from 23% in Northern Ireland to 45% in Norway) and radiotherapy (ranging from 32% in England to 48% in New South Wales and 50% in Newfoundland and Labrador). Across jurisdictions, chemotherapy use decreased steeply with increasing age, regardless of stage at diagnosis. For radiotherapy use, in stage 1–3 cancer three patterns were observed: (a) steep decrease with increasing age (UK jurisdictions, Saskatchewan-Manitoba); (b) a relatively flat pattern (Norway, Alberta, British Columbia, Atlantic Canada, New South Wales) and (c) increasing use with increasing age (Ontario). Time to radiotherapy initiation was longer in the UK jurisdictions than elsewhere; time to chemotherapy was longer in the UK and Canadian jurisdictions except Ontario. Discussion: Use of chemotherapy and radiotherapy in patients with lung cancer varied substantially between jurisdictions during the mid-2010s within age-stage strata. Reasons for these variations are unclear. Differences in non-surgical treatment use are plausibly associated with international variation in lung cancer survival. Journal Article BMJ Oncology 4 1 e000800 BMJ 2752-7948 epidemiology, lung cancer (non-small cell), chemotherapy, lung cancer (small-cell), radiotherapy 11 7 2025 2025-07-11 10.1136/bmjonc-2025-000800 COLLEGE NANME COLLEGE CODE Swansea University Other 2025-07-15T12:59:36.3321958 2025-07-15T12:52:43.6995565 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Matthew E Barclay 0000-0003-1148-1922 1 Sean McPhail 2 Shane A Johnson 3 Ruth Swann 4 Christian J Finley 5 John Butler 6 Riaz Alvi 7 Andriana Barisic 8 Damien B Bennett 9 Oliver Bucher 10 Nicola Creighton 11 Cheryl A Denny 12 Ron A Dewar 13 David W Donnelly 14 Jeff J Dowden 15 Laura Downie 16 Norah Finn 17 Steven Habbous 18 Dyfed Huws 19 S Eshwar Kumar 20 Leon May 21 Carol A McClure 22 Bjørn Møller 23 David S Morrison 24 Grace Musto 25 Yngvar Nilssen 26 Nathalie Saint-Jacques 0000-0003-2532-6472 27 Sabuj Sarker 28 Lorraine Shack 29 Luc te Marvelde 0000-0002-0082-3299 30 Xiaoyi Tian 31 Robert JS Thomas 32 Catherine S Thomson 33 Richard Walton 34 Haiyan Wang 35 Tommy Hon Ting Wong 36 Ryan R Woods 37 Hui You 38 Bin Zhang 39 Georgios Lyratzopoulos 0000-0002-2873-7421 40 69971__34770__634cb0b48b214ddbb90a6fce5aa2385d.pdf bmjonc-2025-000800.pdf 2025-07-15T12:52:43.6762818 Output 3394316 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
spellingShingle Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
Dyfed Huws
title_short Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
title_full Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
title_fullStr Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
title_full_unstemmed Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
title_sort Chemotherapy and radiotherapy use in patients with lung cancer in Australia, Canada, the UK and Norway 2012–2017: an ICBP population-based study
author_id_str_mv d4b1f62e65a55f5ad21c5778c6e03af9
author_id_fullname_str_mv d4b1f62e65a55f5ad21c5778c6e03af9_***_Dyfed Huws
author Dyfed Huws
author2 Matthew E Barclay
Sean McPhail
Shane A Johnson
Ruth Swann
Christian J Finley
John Butler
Riaz Alvi
Andriana Barisic
Damien B Bennett
Oliver Bucher
Nicola Creighton
Cheryl A Denny
Ron A Dewar
David W Donnelly
Jeff J Dowden
Laura Downie
Norah Finn
Steven Habbous
Dyfed Huws
S Eshwar Kumar
Leon May
Carol A McClure
Bjørn Møller
David S Morrison
Grace Musto
Yngvar Nilssen
Nathalie Saint-Jacques
Sabuj Sarker
Lorraine Shack
Luc te Marvelde
Xiaoyi Tian
Robert JS Thomas
Catherine S Thomson
Richard Walton
Haiyan Wang
Tommy Hon Ting Wong
Ryan R Woods
Hui You
Bin Zhang
Georgios Lyratzopoulos
format Journal article
container_title BMJ Oncology
container_volume 4
container_issue 1
container_start_page e000800
publishDate 2025
institution Swansea University
issn 2752-7948
doi_str_mv 10.1136/bmjonc-2025-000800
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
active_str 0
description Background: International variation in lung cancer survival may be partly explained by variation in stage-specific treatment use, but relevant comparative evidence is sparse. As part of the International Cancer Benchmarking Partnership, we examined use of chemotherapy and radiotherapy in population-based cancer registry data. Methods: Linked population-based data sources were used to describe use and time to first treatment for either chemotherapy or radiotherapy in patients with lung cancer diagnosed in study periods during 2012–2017 in 16 jurisdictions of Australia, Canada, the UK and Norway. Results: There was large variation in the proportions of patients with lung cancer receiving chemotherapy (ranging from 23% in Northern Ireland to 45% in Norway) and radiotherapy (ranging from 32% in England to 48% in New South Wales and 50% in Newfoundland and Labrador). Across jurisdictions, chemotherapy use decreased steeply with increasing age, regardless of stage at diagnosis. For radiotherapy use, in stage 1–3 cancer three patterns were observed: (a) steep decrease with increasing age (UK jurisdictions, Saskatchewan-Manitoba); (b) a relatively flat pattern (Norway, Alberta, British Columbia, Atlantic Canada, New South Wales) and (c) increasing use with increasing age (Ontario). Time to radiotherapy initiation was longer in the UK jurisdictions than elsewhere; time to chemotherapy was longer in the UK and Canadian jurisdictions except Ontario. Discussion: Use of chemotherapy and radiotherapy in patients with lung cancer varied substantially between jurisdictions during the mid-2010s within age-stage strata. Reasons for these variations are unclear. Differences in non-surgical treatment use are plausibly associated with international variation in lung cancer survival.
published_date 2025-07-11T05:24:53Z
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