Lung Cancer in Northland, New Zealand: An investigation into lung cancer across Northland DHB 2011-2015

Abstract

Background: The early detection of lung cancer is a fundamental prerequisite to overall survival outcomes. New Zealand’s survival record is below other developed countries. Aim: To explore the diagnosis, morbidity and mortality of lung cancer in Northland using data from 1 January 2011 to 31 December 2015. The study sought to identify factors that were associated with lung cancer staging on diagnosis. Methods: Patients were identified from records sourced from an archived regional database and scheduled Multi-Disciplinary Meeting agendas and thereafter amalgamated with Northland DHB Alpha and Data Warehouse records. Results: A total of 412 cases were identified: 39.6 percent identified as Māori and 60.4 percent Non-Māori, 51.7 percent were females and 48.3 percent were males with a mean age of 69.5 years. Histopathology was gained for 81.3 percent (non-small lung cancer cases) and 18.7 percent received a clinico-radiological diagnosis of lung cancer. The five-year survival probability was recorded as Stage I (50.8%), Stage II (43.0%), Stage III (7.6%) and Stage IV (1.1%) with an overall five-year cohort survival probability of 11.9 percent and median survival estimate of 0.67 years (244.7 days). When comparing curative (Stage I-IIIA) and non-curative (Stage IIIB-IV) intended outcomes using univariate analysis there was a significant relationship between lung cancer and patients experiencing unintentional weight loss 211 (51.2%, p=<0.0001), 243 (59.0%, p=0.034) were diagnosed with ischaemic heart disease and 165 (40.0%, p=0.07) was referred to the hospital setting at time of referral. There was a highly significant relationship between lung cancer and chronic obstructive pulmonary disease using univariate (p=0.001) and multivariate regression (p=<0.001). Threehundred and seventy-eight (91.8%) had a prior history of smoking and 218 (52.9%) resided within the lowest socioeconomically disadvantaged areas (social quintile 5) of Northland. Conclusion: The study demonstrated a strong relationship between lung cancer and chronic obstructive pulmonary disease. Survival rates are poor within the Northland cohort as a result of late-stage presentations.