The impact of cardiovascular co-morbidities on surgical resection rate in patients with Non-Small Cell Lung Cancer: an analysis of the VICORI cardio-oncology programme


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Catherine Welch1,Michael Sweeting1,Mark Rutherford1,Paul Lambert1,Ruth Jack2,David Adlam1,Michael Peake2
1University of Leicester,2Public Health England

Abstract

Background

Surgical resection of tumours is the recommended treatment for patients with early stage Non-Small Cell Lung Cancer (NSCLC). There are significant risks of thoracic surgery which are much higher in patients with serious co-morbidities. This can affect both whether a patient is judged fit for surgery and their risk of peri-operative death. Because >85% of patients with NSCLC are current or ex-smokers, they have a disproportionately high rate of cardiovascular disease (CVD) and respiratory co-morbidities. Previous studies have shown wide variation in resection rates by area of residence but no study has examined the extent to which the incidence of serious CVD could be a factor in this variability.

Method

Using data from NCRAS, we identified all patients diagnosed with NSCLC in England between 2012 and 2015 and, using HES data, identified those who had undergone an interventional cardiovascular procedure before the date of diagnosis. We examined if having undergone an interventional procedure for CVD influenced the likelihood of undergoing surgical resection.

We produced funnel plots of crude resection rate by Clinical Commissioning Group (CCG; area of residence at the time of diagnosis) and adjusted for CVD procedures before NSCLC diagnosis, age at diagnosis, sex and cancer stage at diagnosis.

Results

Of the 127,032 NSCLC patients we identified, 18,801 (14.8%) had a resection. We observed wide variation in crude resection rate by CCG. Of the NSCLC patients 9,666 (7.6%) had a CVD procedure before diagnosis and were older, more likely to be male and with lower cancer stage at diagnosis compared to those with no CVD procedure before diagnosis. However, adjusting for CVD procedure before NSCLC diagnosis did not reduce resection rate variation by CCG.

Conclusion

CVD co-morbidity did not explain resection rate variation by CCG. Future work will focus on how CVD affects risk of resection or death.