Lung Cancer Under Siege in Spain: Timeliness, Treatment, and Survival Before and After the COVID-19 Pandemic
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Inclusion and Exclusion Criteria
2.3. Study Population
2.4. Data Collection and Assessment of Lung Cancer Care Timelines
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Lung Cancer Diagnoses and Diagnostic Efficiency
3.3. Treatment Rates and Modalities
3.4. Timeliness of Diagnoses and Treatment
3.5. Survival Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
LC | Lung Cancer |
NSCLC | Non-Small Cell Lung Cancer |
SCLC | Small Cell Lung Cancer |
ECOG | Eastern Cooperative Oncology Group |
FDT | First Definitive Treatment |
SBRT | Stereotactic Body Radiation Therapy |
CT | Computed Tomography |
PET | Positron Emission Tomography |
EGFR | Epidermal Growth Factor Receptor |
ALK | Anaplastic Lymphoma Kinase |
PD-L1 | Programmed Death-Ligand 1 |
HR | Hazard Ratio |
CI | Confidence Interval |
LCCA | Lung Cancer Care Andalusia (Andalusian Clinical Practice Guidelines) |
BTS | British Thoracic Society |
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Characteristics | 2019 n = 179 | 2020 n = 145 | 2021 n = 206 | p-Value | |
---|---|---|---|---|---|
Median age (years) | 65 | 64 | 67 | 0.0368 | |
Sex [n (%)] | Male | 146 (81.56%) | 114 (78.62%) | 160 (77.67%) | NS |
Female | 33 (18.44%) | 31 (21.38%) | 46 (22.33%) | ||
Smoking history [n (%)] | Former/current smoker | 168 (94.92%) | 130 (90.91%) | 187 (91.22%) | NS |
Non-smoker | 9 (5.08%) | 13 (9.09%) | 18 (8.78%) | ||
ECOG performance status [n (%)] | 0–1 | 104 (65.41% | 96 (78.80%) | 143 (76.06%) | 0.0411 |
>1 | 55 (34.58%) | 29 (23.20%) | 45 (23.94%) | ||
Subtype/Histology [n (%)] | NSCLC | 135 (79.88%) | 116 (85.29%) | 169 (84.08%) | NS |
SCLC | 34 (20.12%) | 20 (14.71%) | 32 (15.92%) | ||
Unknown | 10 (5.59%) | 9 (6.21%) | |||
NSCLC Subtype (n/%) | Adenocarcinoma | 88 (66.17%) | 63 (55.26%) | 95 (56.89%) | NS |
Squamous | 33 (24.81%) | 39 (34.21%) | 64 (38.32%) | ||
Others * | 12 (9.02%) | 12 (10.53%) | 8 (4.79%) | ||
Biomarkers | EGFR Mutation | NS | |||
Positive Negative | 9 (12%) 66 (88%) | 6 (10%) 54 (90%) | 6 (7.89%) 70 (92.1%) | ||
ALK translocation | NS | ||||
Positive Negative | 0 (0%) 72 (100%) | 2 (3.4%) 58 (96.6%) | 2 (2.7%) 71 (97.3%) | ||
PD-L1 expression | NS | ||||
<1% 1–49% >50% | 39 (40.2%) 28 (28.8%) 30 (31%) | 50 (54.4%) 21 (22.8%) 21 (22.8%) | 51 (48.5%) 28 (26.7%) 26 (24.8%) | ||
Cancer Stage [n (%)] | Early stage 1 | 28 (15.64%) | 23 (15.86%) | 37 (17.96%) | NS |
Locorregional 2 | 28 (15.64%) | 34 (23.45%) | 53 (25.73%) | ||
Advanced/metastatic stage 3 | 123 (68.72%) | 88 (60.69%) | 116 (56.31%) | ||
Treatment type [n (%)] | FDT 4 | 125 (69.83%) | 102 (70.34%) | 151 (73.30%) | NS |
PT 5 | 54 (30.17%) | 43 (29.66%) | 55 (26.70%) | ||
First consultation with pulmonary specialist [n (%)] | Outpatient referral from GP | 37 (20.67%) | 30 (20.69%) | 44 (21.36%) | NS |
Inpatient consult | 37 (20.67%) | 37 (25.52%) | 58 (28.16%) | ||
Referral from emergency department | 105 (58.66%) | 78 (53.79%) | 104 (50.59%) |
Variables | 2019 | 2020 | 2021 |
---|---|---|---|
Number of new lung cancer diagnoses | 179 | 145 | 206 |
Average per month | 15 | 12 | 17 |
Change vs. previous year | − | −19% | +42% |
Type of FTD | Total | 2019 n = 125 | 2020 n = 102 | 2021 n = 151 | p-Value |
---|---|---|---|---|---|
Surgery (n/%) | 76 (14.34%) | 22 (12.29%) | 23 (15.86%) | 31 (15.05%) | NS |
Definitive radiation (n/%) | 22 (4.15%) | 7 (3.91%) | 4 (2.76%) | 11 (5.34%) | NS |
Conventional | 12 (2.26%) | 4 (2.23%) | 0 (0.00%) | 8 (3.88%) | |
SBRT | 10 (1.89%) | 3 (1.68%) | 4 (2.76%) | 3 (1.46%) | |
Definitive chemoradiation (n/%) | 79 (14.90%) | 20 (11.17%) | 22 (15.18%) | 37 (17.96%) | NS |
Concurrent chemoradiation | 44 (8.30%) | 13 (7.26%) | 14 (9.66%) | 17 (8.25%) | |
Sequential chemoradiation | 35 (6.60%) | 7 (3.91%) | 8 (5.52%) | 20 (9.71%) | |
Palliative radiation (n/%) | 38 (7.17%) | 22 (12.29%) | 7 (4.83%) | 9 (4.37%) | 0.0048 |
Systemic (n/%) | 163 (30.75%) | 54 (30.17%) | 46 (31.72%) | 63 (30.58%) | NS |
Standard systemic chemotherapy | 111 (20.94%) | 42 (23.46%) | 32 (22.07%) | 37 (17.96%) | |
Immunotherapy ± Chemotherapy | 41 (7.74%) | 9 (5.03%) | 9 (6.21%) | 23 (11.17%) | |
Targeted therapy | 11 (2.08%) | 3 (1.68%) | 5 (3.45%) | 3 (1.46%) | |
Symptom-directed (palliative care) | 152 (28.68%) | 54 (30.17%) | 43 (29.66%) | 55 (26.70%) | NS |
Interval | 2019 | 2020 | 2021 | p-Value |
---|---|---|---|---|
Referral → LC specialist (≤7 days) | 2 (1.0; 7.0) | 1 (1.0; 5.0) | 1 (1.0; 6.0) | NS |
Referral → Diagnosis (≤30 days) | 19 (14.0; 29.0) | 14 (11.0; 22.0) | 14 (11.0; 22.2) | <0.0001 |
Pathology report (≤7 days) | 7 (6.0; 9.5) | 6 (6.0; 8.0) | 6 (6.0; 8.0) | 0.0001 |
Molecular results (≤14 days) | 11 (8.0; 18.0) | 13 (8.0; 21.0) | 15 (10.5; 22.0) | 0.0226 |
Diagnosis → FDT 2 (≤42 days) | 33 (20.0; 50.5) | 34.5 (23.25; 49.0) | 35.5 (23.0; 54.0) | NS |
Interval (Days) | 2019 | 2020 | 2021 | p-Value |
---|---|---|---|---|
Referral → LC specialist (≤7 days) | 77.69% | 81.44% | 80.54% | 0.7518 |
Referral → Diagnosis (≤30 days) | 80.98% | 84.80% | 83.70% | 0.6630 |
Pathology report (≤7 days) | 55.21% | 74.40% | 73.37% | 0.0002 |
Molecular results (≤14 days) | 44.59% | 64.15% | 40.91% | 0.0278 |
Diagnosis → Treatment (≤42 days) | 65.25% | 66.67% | 61.43% | 0.6839 |
Variables | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Age (vs ≤ 70 years) | 1.15 (0.86, 1.53) | NS | 1.23 (0.89–1.70) | NS |
Female sex (vs. male) | 0.64 (0.47, 0.96) | 0.027 | 0.84 (0.57–1.23) | NS |
Ever-smoker (vs. never) | 1.84 (1.21–2.86) | 0.008 | 1.79 (0.90–3.57) | NS |
ECOG performance status (vs 0–1) ≥2 | 3.97 (2.87, 5.50) | <0.001 | 3.34 (2.28, 4.90) | <0.001 |
Histology (vs. SCLC) | 0.51 (0.07, 3.68) | <0.001 | 0.70 (0.49, 0.98) | 0.038 |
Stage (vs. Early stage-NSLC) Locally-Advanced + Limited Advanced + Extended | 3.87 (2.21, 6.76) 9.29 (5.53, 15.6) | <0.001 <0.001 | 3.28 (1.26, 8.52) 6.62 (2.53, 17.3) | 0.015 <0.001 |
First treatment (vs. Surgery) Definitive radiation Definitive chemoradiation Palliative Radiation Systemic (chemo and/or immunotherapy) | 2.08 (0.95, 4.55) 2.88 (1.64, 5.08) 17 (9.34, 30.93) 7.12 (4.28, 11.8) | NS <0.001 <0.001 <0.001 | 0.89 (0.36, 2.21) 0.72 (0.30, 1.74) 1.92 (0.77, 4.75) 0.94 (0.40, 2.19) | NS NS NS NS |
Year of diagnosis (vs. Pre-COVID-19) 1st year of COVID-19 2nd year of COVID-19 | 0.74 (0.53, 1.04) 0.78 (0.58, 1.06) | NS NS | 0.98 (0.68, 1.41) 1.18 (0.84, 1.64) | NS NS |
Wait times 1st appointment → Diagnosis ≥30 days Diagnosis → 1st treatment ≥42 days | 0.74 (0.51, 1.06) 0.82 (0.61, 1.16) | NS NS | 0.78 (0.54, 1.14) 0.90 (0.65, 1.24) | NS NS |
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Blanco-Villar, M.L.; Expósito-Hernández, J.; Navarro-Moreno, E.; Aparicio Mota, A.; López Martín, J.M. Lung Cancer Under Siege in Spain: Timeliness, Treatment, and Survival Before and After the COVID-19 Pandemic. Cancers 2025, 17, 2655. https://doi.org/10.3390/cancers17162655
Blanco-Villar ML, Expósito-Hernández J, Navarro-Moreno E, Aparicio Mota A, López Martín JM. Lung Cancer Under Siege in Spain: Timeliness, Treatment, and Survival Before and After the COVID-19 Pandemic. Cancers. 2025; 17(16):2655. https://doi.org/10.3390/cancers17162655
Chicago/Turabian StyleBlanco-Villar, Manuel Luis, José Expósito-Hernández, Eulalia Navarro-Moreno, Adrián Aparicio Mota, and José María López Martín. 2025. "Lung Cancer Under Siege in Spain: Timeliness, Treatment, and Survival Before and After the COVID-19 Pandemic" Cancers 17, no. 16: 2655. https://doi.org/10.3390/cancers17162655
APA StyleBlanco-Villar, M. L., Expósito-Hernández, J., Navarro-Moreno, E., Aparicio Mota, A., & López Martín, J. M. (2025). Lung Cancer Under Siege in Spain: Timeliness, Treatment, and Survival Before and After the COVID-19 Pandemic. Cancers, 17(16), 2655. https://doi.org/10.3390/cancers17162655