Equal lung cancer care but worse psychological well-being

Annually, 4,200 people in Sweden are diagnosed with lung cancer, of which approximately 85% are of the non-small cell type. The thesis, which includes patients diagnosed with non-small cell lung cancer, shows that Sweden offers equal care for lung cancer to a large extent. This is based on socio-economics, age and origin when taking into account the patients' general condition, co-morbidity and other factors that can influence the choice of care and treatment.

– Previous reports have highlighted inequalities, but here we can see that those differences disappear when we can compensate for factors that the doctor must take into account before choosing which treatment is right for each individual patient, says Linda Willén, senior physician in Oncology.

After her research team adjusted for general condition, comorbidities and other factors that may affect management, only small differences in non-small cell lung cancer care and survival remained.

– Highly educated patients were offered to a slightly higher extent investigations and treatments that were new during the time period and had slightly better survival in the early stages of the disease. Older patients were examined to the same extent as younger patients up to the age of 80.

Age adjustments were made in the choice of treatment. There were also differences in survival in early stages of the disease where survival was poorer for older patients. Two-thirds of patients 80–84 years of age and one-third of patients 85 years of age or older were offered cytostatic treatment for disseminated disease.

– At diagnosis, foreign-born patients were younger, had a higher education and a better general condition compared to Swedish-born patients. After correcting for age, only small differences were seen in investigation and treatment, in early stages slightly better survival was seen in those born abroad compared to those born in Sweden, says Linda Willén.

The thesis also shows that lung cancer patients after diagnosis have a worse psychological well-being compared to other Swedes. The risk of depression, anxiety, poisoning (alcohol, morphine, sleeping pills and other sedatives) and suicide is elevated in the first months after diagnosis. The increased risk of anxiety, depression and suicide decreased over time, while the increased risk of poisoning persisted throughout the time period studied. The findings confirm previous research in the area.

– A cancer diagnosis is difficult for most patients to receive, and for some it triggers a crisis reaction that is difficult to get out of. Here, it is important that we in healthcare catch these patients and give them the best possible support, says Linda Willén.

Method: The studies in the thesis are registry studies based on the research database Lung Cancer Database Sweden, where information from the Swedish Lung Cancer Registry is linked with information from several other official registries of the Swedish population. The database spans the time period 2002 to 2016 and contains approximately 40,000 patients with non-small cell lung cancer, which corresponds to more than 95% of all those diagnosed during that time period.

Linda Willén grew up in Lund and studied at the medical program in Umeå. She works as a senior physician at the Oncology Clinic at Gävle Hospital and has completed her thesis via the Department of Radiation Sciences at Umeå University.