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Regional variations in molecular testing and treatment of patients with metastatic NSCLC in the Netherlands
Jente M Klok1, Z L Rana Kaplan2, Marthe S Paats3
1Department of Respiratory Medicine, Erasmus Cancer Institute University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands; Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands.
Background:
Molecular testing combined with targeted therapy has led to a rapid improvement of patient outcomes in metastatic non-small cell lung cancer (NSCLC). However, previous reports suggested that the use of these treatment modalities might vary between geographic regions within countries. We aimed to examine variation in diagnostics and treatment of non-squamous metastatic NSCLC.
Methods:
We compared five Dutch regions using population-based data from the Netherlands Cancer Registry (2020-2023). Variation in molecular testing and first-line targeted therapy across regions was assessed with the likelihood-ratio test (LRT) of a multivariable logistic regression model. This model included region as a variable, and accounted for patient characteristics such as sex, age, programmed death-ligand 1 (PDL-1) status, year of diagnosis and World Health Organization performance status. Variation in treatment was also assessed with the LRT in patients with actionable genetic aberrations.
Results:
A total of 16,655 patients (median age 69 [62, 75]; 52% male) were diagnosed with metastatic non-squamous NSCLC. Of these patients, 14,297 (86%) underwent molecular testing, ranging from 82% to 91% between regions (p < 0.001). 1470 patients had an actionable genetic aberration, of which 1252 (85%) received targeted therapy, ranging from 82% to 89% (p = 0.17).
Conclusion:
The application of molecular testing in metastatic non-squamous NSCLC varies across regions in the Netherlands, while minimal variation was observed in the application of targeted therapy. These findings highlight the need for better collaboration between regions to optimize guidelines and ensure uniform care.
Insights
Molecular testing for metastatic non-small cell lung cancer (NSCLC) varies by region in the Netherlands. Targeted therapy use is more uniform, indicating a need for improved regional collaboration to ensure consistent patient care.
Area of Science:
- Oncology
- Genomics
- Public Health
Background:
- Targeted therapy and molecular testing have improved outcomes in metastatic non-small cell lung cancer (NSCLC).
- Geographic variations in diagnostic and treatment modalities for NSCLC have been previously suggested.
- Understanding regional disparities is crucial for optimizing cancer care delivery.
Purpose of the Study:
- To investigate regional variations in molecular testing and targeted therapy for non-squamous metastatic NSCLC in the Netherlands.
- To assess the impact of patient characteristics on diagnostic and treatment patterns.
- To identify areas for improvement in NSCLC care uniformity.
Main Methods:
- Population-based data from the Netherlands Cancer Registry (2020-2023) for 16,655 patients with metastatic non-squamous NSCLC.
- Multivariable logistic regression and likelihood-ratio tests were used to analyze regional variation.
- Patient factors including age, sex, PD-L1 status, and performance status were controlled for.
Main Results:
- Molecular testing was performed in 86% of patients, with significant regional variation (82%-91%, p < 0.001).
- Of 1470 patients with actionable aberrations, 85% received targeted therapy, showing minimal regional variation (82%-89%, p = 0.17).
- Significant differences in molecular testing rates were observed across five Dutch regions.
Conclusions:
- Regional disparities exist in molecular testing for metastatic non-squamous NSCLC within the Netherlands.
- Targeted therapy application demonstrates greater uniformity across regions.
- Enhanced regional collaboration is recommended to standardize guidelines and ensure equitable patient care.
