Lung Resection for Stage 1 Patients

Key findings

In 2017, 55% of stage 1 lung cancer patients (non-small cell lung cancer and small cell lung cancer) had surgery compared with 62% in 2013. The proportion of patients who have surgical resection varies by age, at 89% of stage 1 lung cancer patients under age 50 compared with 25% of those ages 80 and above.

Why is this important to Ontarians?

Surgical resection is the treatment of choice for early stage non-small cell lung cancer. Patients with stage 1 disease have the most favourable prognosis.^[1]
A population-based study concluded that survival was favourable for resected early stage non-small cell lung cancer patients, including groups such as elderly patients and those with multiple tumours.^[2]
Small cell lung cancer is not generally treated with surgery, as the cancer has often spread to other parts of the body at the time of diagnosis and responds better to chemotherapy and radiation therapy.^[3]

See Lung Resection for Stage 1 Patients Methodology for technical information.

Report date: May 2019
Data sources: Ontario Cancer Registry, Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), Canadian Institute for Health Information’s National Ambulatory Care Reporting System (CIHI-NACRS)
Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 1: Proportion of patients diagnosed with stage 1 lung cancer who had surgery within 180 days of diagnosis, 2013 to 2017
Year of Diagnosis	Percentage patients diagnosed with Stage 1 Lung Cancer that had a surgery within 180 days of diagnosis
2013	62.2
2014	61.6
2015	61.6
2016	59.0
2017	54.8

Data Table 2: Proportion of patients diagnosed with stage 1 lung cancer who had surgery within 180 days of diagnosis, by age, 2017
Age of Diagnosis	Percentage patients diagnosed with Stage 1 Lung Cancer in 2017 that had a surgery within 180 days of diagnosis by age
<50	88.6
50-64	73.1
65-79	57.8
80+	25.4

Data Table 1: Proportion of patients diagnosed with stage 1 lung cancer who had surgery within 180 days of diagnosis, 2013 to 2017

Data Table 2: Proportion of patients diagnosed with stage 1 lung cancer who had surgery within 180 days of diagnosis, by age, 2017

Results

In 2017, 55% of stage 1 lung cancer patients had surgery compared with 62% in 2013.
Surgery volumes for stage 1 have fluctuated, with a low of 1,579 surgeries in 2013 and a high of 2,048 in 2016.
The proportion of patients having surgical resection varies by age, at 89% of stage 1 lung cancer patients under age 50 compared with 25% of patients ages 80 and above.

Opportunities

Surgery is not common for small cell lung cancer patients, because it is not appropriate care for many of those patients. Further investigation into the pathology of lung resection patients will be done by the Surgical Oncology Program.
Advances in treatment include preoperative radiation therapy, an emerging primary treatment for non-small cell lung cancer. This may explain the decreasing percentage of patients receiving surgery.

For more information

For more information about the Surgical Oncology Program, visit the Surgical Oncology Program on Cancer Care Ontario’s website.

Visit Quality Improvement Resources for Surgical Oncoloy for resources to help physicians learn about, discuss and provide feedback on quality issues in cancer.

References

Hung, J. J., Hsu, W. H., Hsieh, C. C., Huang, B. S., Huang, M. H., Liu, J. S., & Wu, Y. C. (2009). Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence. Thorax, 64(3), 192-196.
Strand, T. E., Rostad, H., Møller, B., & Norstein, J. (2006). Survival after resection for primary lung cancer: a population based study of 3211 resected patients. Thorax, 61(8), 710-715.
National Cancer Institute. Small Cell Lung Cancer Treatment (PDQ®)–Health Professional Version [Internet]. [cited 2019 June 03]. Available from: https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq