Definition: The percentage of patients diagnosed with stage II or IIIA non-small cell lung cancer (NSCLC) who received post-operative chemotherapy within 120 days of resections
Rationale for measurement: The delivery of chemotherapy following resection has been shown to improve outcomes (i.e., disease-free and overall survival) and prevent recurrences in patients with Stage II and IIIA NSCLC, compared with surgery alone. Clinical practice guidelines therefore recommend post-operative chemotherapy for patients with Stage II and IIIA NSCLC.
Measurement timeframe: Diagnosis years 2011 to 2014
Denominator: Stage II and IIIA non-small cell lung cancer cases diagnosed during the timeframe and having a lung resection within one year of diagnosis.
Numerator: Stage II and IIIA non-small cell lung cancer cases having post-operative chemotherapy within 120 days of resections, which were diagnosed during the timeframe and receiving resections within one year of diagnosis
Exclusion criteria: Cases with age ≤ 17 were excluded.
Data availability:
- 2011-2014: AB, SK, MB, ON, NS, NL and PE
- 2011-2013: BC
Stratification:
Data were aggregated at national level:
- By year and age group: 18-59, 60-69, 70-79, 80+
Data were aggregated at provincial level:
- By year
Data source: Provincial cancer agencies and programs
Data retrieval date: October 2017
Variables details:
Cancer definition:
- Non-small cell lung cancer (NSCLC) was defined as C34 in ICD-O3 with behavior code 3 (invasive). Cancer cases with lymphoma codes M-95 to M-98, sarcoma codes (see Appendix A), and 8002, 8041, 8043, 8044, 8045, and 8803, 8042 were excluded
- Non-small lung cancer cases were restricted to stage II and stage IIIA in AJCC.
Resection identification:
- Lung resections were identified in CCI codes as 1GR87, 1GR89, 1GR91, 1GT59, 1GT87, 1GT89, 1GT91, or 1GV87.
Treatment criteria:
- Chemotherapy included oral (as available in data) and IV chemotherapy.
- All lung resections were within 1 year of diagnosis. If there were multiple resections, the last resection was counted:
Last resection date (if multiple) – diagnosis date ≤ 365 days
- All post-operative chemotherapy were within 120 days after resections:
Chemo start date – Last resection date (if multiple) ≤120 day
Notes from jurisdictions:
- AB: The ACR codes out of province treatment to provincial residents if they are notified and/or it is mentioned in the documents. The following small-cell morphologies were excluded: 8002, 8041, 8042, 8043, 8044, 8045, 8803. For Step3 cases with both neo-adjuvant and adjuvant chemotherapy were excluded.
- SK: Chemo includes oral and intravenous (IV). We are unable to differentiate between the two modalities in Saskatchewan.
- MB: Oral chemotherapy data is only recorded if it is documented in the chart.
- ON: For oral data-Oral chemotherapy included if available but may not be complete. DAD/NACRS and ALR were included. ODB wasn't included.
- NS: These numbers differ from what had been provided in the past for a number of reasons. First, we are no longer using site-specific factors in the Collaborative Stage data to identify resections. Instead, we have used DAD/NACRS data. Second, the DAD/NACRS data include a small number of persons who received their surgical resection(s) outside Nova Scotia as well, which is a first. However, we will not have treatment data for these persons if they received treatment outside Nova Scotia, so it's possible the percentage receiving chemo could be slightly underestimated. Third some histology codes associated with NSCLC were excluded along with other squamous cell carcinoma in the past.
- PE: Oral data would be included if known about.
Methodology notes:
- Data presented include stage II and IIIA combined
- The cancer incidence sites/types were classified by World Health Organization, International Classification of Diseases for Oncology, Third Edition (ICD- O-3).
- American Joint Committee on Cancer (AJCC) Cancer Staging Manual 7th edition was used to classify cancer stage groups.
- The Canadian Classification of Health Interventions (CCI) codes were used to identify surgery types, except AB.
Changes to definition compared to previous years: Not applicable
