Standard 1.12 Public Reporting of Outcomes for Lung Cancer

UH-Portage Medical Center (UH-PMC): Lung Cancer, 2019

Introduction: Lung cancer is the second most commonly diagnosed cancer in the U.S. and the most common cause of cancer death in both men and women. 1 in 15 men and women will be diagnosed with lung cancer in their lifetimes. An estimated 1,762,450 new cases of lung cancer will be diagnosed in the U.S. and 9,680 in Ohio in 2019. There will be approximately 606,680 lung cancer deaths in the U.S. and 6,690 in Ohio. 85% of all lung cancers are non-small cell carcinomas (NSCLC) with small cell carcinoma making up most of the other 15%. The most common risk factor, by far, is cigarette smoking, followed by exposure to radon gas, asbestos, diesel exhaust, some heavy metals, other toxins and air pollution.

Incidence of non-small cell lung cancer by stage: Cases diagnosed at UH-PMC vs. All Ohio hospitals (2015-2016)
UH-PMC (N/%) Ohio hospitals (N/%)
Stage 0 0 (0%) 64 (0.4%)
Stage I 30 (36%) 3957 (28%)
Stage II 13 (16%) 1350 (9%)
Stage III 19 (23%) 2883 (20%)
Stage IV 21 (25%) 5851 (41%)
Total 84 14,384

Non-small cell lung cancers tended to diagnosed at UH-PMC at an earlier stage than those in other Ohio hospitals.

Age at diagnosis: Ages at time of diagnosis of non-small cell lung cancer: UH-PMC vs. Ohio hospitals (2015-2016)
UH-PMC (N/%) Ohio hospitals (N/%)
0-29 yrs. 0 (0%) 21 (0.1%)
30-39 yrs. 0 (0%) 65 (0.4%)
40-49 yrs. 3 (4%) 460 (3%)
50-59 yrs. 15 (18%) 2600 (18%)
60-69 yrs. 22 (26%) 4446 (31%)
70-79 yrs. 32 (38%) 4406 (32%)
80-89 yrs. 12 (14%) 2010 (14%)
90+ yrs. 0 (0%) 176 (1%)
Total 84 14,384

Compared to other patients diagnosed in Ohio, UH-PMC patients were very similar in age at the time of diagnosis.

Treatment: Depending on the stage of the cancer and other patient factors, patients may be treated with one or more of the following modalities: surgery, radiation therapy, chemotherapy, immunotherapy or supportive care only.

First courses of treatment for NSCLC: UH-PMC vs. Other Ohio hospitals (2015-2016):
UH-PMC (N/%) Ohio hospitals (N/%)
Surgery only 10 (12%) 2543(18%)
Surgery + chemotherapy 8 (10%) 666 (5%)
Chemotherapy only 14 (17%) 1507 (10%)
No treatment 31 (37%) 2485 (17%)
Surgery + RT 1 (1%) 94 (1%)
Radiation + chemo 10 (12%) 3205 (22%)
Surgery + RT + chemo 1 (1%) 424 (3%)
Chemo + biologic therapy 1 (1%) 203 (1%)
Radiation therapy only 7 (8%) 2733 (19%)

The first courses of treatment for patients diagnosed at UH-PMC were similar to those given to patients from all other Ohio hospitals. At least some of the statistics were affected by the smaller number of patients treated at PMC compared to other Ohio hospitals.

Prevention and screening: The 5-year survival for patients with lung cancer is only 19%, partly because most have advanced stage disease at the time of diagnosis. The National Lung Screening Trial showed that low dose CT scanning (LDCT) reduces the relative risk of death from lung cancer by 20%. LDCT scanning was started at UH-PMC in 2018 and 25 people were screened. Our goal was to increase the number of screenings in 2019. By July 2019, 39 have been screened. At the Family Health and Safety Day, held at UH-PMC on July 20, 2019, 4 people met NCI/NCCN Guidelines criteria for LDCT screening and were advised to contact their primary care physicians.

Conclusions: Lung cancer is a devastating disease and a national and global public health problem, ranking first in causes of cancer death in the US and in the world. At University Hospitals-Portage Medical Center the ages and stages of patients diagnosed with NSCLC in 2015-2016 are very similar to those of other Ohio hospitals. The first courses of treatment correlated fairly well with other hospitals, given the relatively low numbers which can affect the statistical significance of the data. The use of low dose CT screening for lung cancer at UH-PMC has increased significantly over the past year and will continue. Hopefully, earlier detection and better treatments will reduce the number of deaths due to lung cancer.

Frederick P. Marquinez, M.D.
Chairman, UH-Portage Medical Center Cancer Committee