Small-cell lung cancer in England: trends in survival and chemotherapy using the National Lung Cancer Audit

PLoS One. 2014 Feb 21;9(2):e89426. doi: 10.1371/journal.pone.0089426. eCollection 2014.


Background: The purpose of this study was to identify trends in survival and chemotherapy use for individuals with small-cell lung cancer (SCLC) in England using the National Lung Cancer Audit (NLCA).

Methods: We used data from the NLCA database to identify people with histologically proven SCLC from 2004-2011. We calculated the median survival by stage and assessed whether patient characteristics changed over time. We also assessed whether the proportion of patients with records of chemotherapy and/or radiotherapy changed over time.

Results: 18,513 patients were diagnosed with SCLC in our cohort. The median survival was 6 months for all patients, 1 year for those with limited stage and 4 months for extensive stage. 69% received chemotherapy and this proportion changed very slightly over time (test for trends p = 0.055). Age and performance status of patients remained stable over the study period, but the proportion of patients staged increased (p-value<0.001), mainly because of improved data completeness. There has been an increase in the proportion of patients that had a record of receiving both chemotherapy and radiotherapy each year (from 19% to 40% in limited and from 9% to 21% in extensive stage from 2004 to 2011). Patients who received chemotherapy with radiotherapy had better survival compared with any other treatment (HR 0.24, 95% CI 0.23-0.25).

Conclusion: Since 2004, when the NLCA was established, the proportion of patients with SCLC having chemotherapy has remained static. We have found an upward trend in the proportion of patients receiving both chemotherapy and radiotherapy which corresponded to a better survival in this group, but as it only applied for a small proportion of patients, it was not enough to change the overall survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • England / epidemiology
  • Female
  • Humans
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Registries
  • Small Cell Lung Carcinoma / drug therapy
  • Small Cell Lung Carcinoma / mortality*
  • Small Cell Lung Carcinoma / pathology
  • Survival Rate / trends

Grant support

RBH has a grant provided by the British Lung foundation chair of respiratory epidemiology and has a minor consultancy role with GSK concerning people with lung fibrosis where he was paid £350. He is also a co-applicant on a grant for £500,000 from GSK to look at biomarkers for lung fibrosis. AK is also doing his PhD from the University of Nottingham on a studentship provided by the British Lung Foundation. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.