30-day mortality after systemic anti-cancer treatment for breast and lung cancer in England – which factors affect the risk? – the first national population based study


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Emma Saxon1,Michael Wallington2,Matthew Wickenden1,David Dodwell2,Martine Bomb2,Rebecca Smittenaar3,Sean McPhail2,Jem Rashbass2
1Cancer Research UK,2Public Health England,3Cancer Rsearch UK

Abstract

Background

30-day mortality is likely to be a useful indicator of avoidable harm to patients from systemic anti-cancer therapies but there’s been limited data on it. The English Systemic Anti-Cancer Therapy (SACT) dataset, established in 2012, allows us to assess factors affecting 30-day mortality in a national patient population and we can now report insights from our first analyses for breast and lung cancer. As far as we are aware this study is the first in the world to establish levels of 30-day mortality among a national patient population.

Method

Using the SACT dataset, we calculated 30-day mortality following the most recent cycle of SACT in 2014 for breast and lung cancer patients in England. We carried out logistic regression analyses, adjusting for relevant factors, to examine whether patient, tumour, or treatment-related factors were associated with the risk of 30-day mortality.

Results

30-day mortality was significantly higher for a number of factors - shown using odds ratios (OR) - including;

  • patients with the worst performance status (PS) 2-4 vs. PS 0 (breast curative 6·057; breast palliative 6·24; NSCLC palliative 3·384); 
  • older breast and NSCLC patients given curative SACT (breast 1·085, NSCLC 1.045);
  • younger breast cancer and NSCLC patients given palliative SACT (breast 0·987, NSCLC 0·987).

Conclusion

Our analysis of the SACT dataset for the first time provides national benchmarks around 30-day mortality based on the cancer patient population of the English NHS.

It indicates that treatment intent, patient age and performance status all affect 30-day mortality risk and that for certain patient groups the risk is higher than for patients included on relevant clinical trials.

There is huge potential to use this information and the SACT dataset to support NHS hospital trusts and clinicians to review and improve the care of their cancer patients.