Objectives/purpose: This study aims to report treatment utilisation and prognosis in patients in Victoria who received active treatment in the past 12 years using linked administrative datasets.
Sample and setting: Adult patients diagnosed with incident primary lung cancer in 2011-2022, as identified in the data linkage between Victorian Cancer Registry, Victorian Admitted Episodes Dataset (VAED) and Victorian Radiotherapy Minimum Data Set (VRMDS).
Procedures: Thoracic surgery or chemotherapy recorded in VAED, or radiation therapy recorded in VRMDS, performed within one year of diagnosis.
Results: This study included 25,139 patients who received thoracic surgery, chemotherapy or radiation therapy. Among these patients, surgery utilisation remained stable (31% in 2011-2013, 32% in 2014-2016, 31% in 2017-2019, and 30% in 2020-2022). Among patients who received multimodal treatments (N = 9,868), surgery utilisation declined significantly over time, from 30% in 2011-2013 and 29% in 2014-2016 (p = 0.34), to 24% in 2017-2019 (p < 0.001) and 23% in 2020-2022 (p < 0.001). After adjusting for age at diagnosis, sex, comorbidity count and socioeconomic status, overall survival improved significantly over the study period when compared with patients diagnosed in 2011-2013 (hazard ratio [HR] for 2014-2016: 0.90 [0.86, 0.94]; 2017-2019: 0.75 [0.72, 0.78]; 2020-2022: 0.72 [0.69, 0.76]).
Conclusion and clinical implications: Despite notable improvements in survival, surgery utilisation has not increased over time, particularly among patients received multimodal treatment. This study establishes a benchmark for historic treatment practices. It will serve as a reference baseline for evaluating the impact of two new major changes in lung cancer surgery – the National Lung Cancer Screening Program for early stage diseases, and pre-operative chemo-immunotherapy and surgery for locally advanced diseases.