(B-010) Incidence Trends and Characterisation of Lung Cancer: a Multinational European Cohort Study

Background: Lung cancer is the leading cause of cancer-associated mortality worldwide. New diagnoses are predicted to nearly double by 2070 meaning it will continue to be a major cause of morbidity and mortality globally.

Objectives: To estimate secular trends in lung cancer incidence, and to characterise lung cancer presentation in European real world data.

Methods: Population-based cohort study using THIN (The Health Improvement Network) databases (Belgium, Italy, Romania and Spain) and the UK primary care Clinical Practice Research Datalink (CPRD) GOLD database. Individuals aged 18+ with at least one year of prior history were included. The study period was from 2003 to 2023 or from the start of usable data. We estimated yearly age standardised incidence rates (IRs), stratified by sex, using the European Standard population 2013. The characteristics of lung cancer patients 365 - 31 days before and after diagnosis were compared to age and sex matched controls to identify key differential presentation features. Standardised mean difference (SMD) for lung cancer cases vs controls were estimated.

Results: We included 60,779 lung cancer patients in total. Median age at diagnosis ranged from 67 to 72 years, and 53.4% - 69.4% of patients were male. Secular trends of incidence varied by database, with higher IRs for males (e.g. 71.90 (M), 66.39 (F) for 2022 for CPRD GOLD). Except for Italy, IRs declined over time or were stable for males, whereas for females IRs increased in most databases apart from THIN Romania and Belgium (e.g. for CPRD GOLD IRs in females increased from 43.45 per 100,000 person-years in 2003 to 66.39 in 2022 ,whereas for males IRs remained stable (73.41 to 71.90)). Before diagnosis, lung cancer patients had higher prevalence of respiratory symptoms such as cough (SMD 0.12–0.40), and conditions like COPD (0.23–0.55) across databases. Likely related to these, amoxicillin (0.15–0.58), acetaminophen (0.13–0.41) and albuterol (0.20–0.54) were more common in the lung cancer group. Post-diagnosis, respiratory conditions persisted but also pain (0.20–0.21) and cancer treatment-related effects (e.g. nausea (0.18–0.31)) were commonly observed. Medications related to pain and palliative care management (e.g. morphine (0.6-1.2)) as well as medications used for nausea (e.g. dexamethasone (0.10–0.85)) were common.

Conclusions: Incidence rates vary across countries, reflecting differences in risk factors and healthcare. Patient characteristics showed a shift from only pre-diagnosis respiratory symptom management to post diagnosis cancer management, treatment side-effects, and palliative care. Our findings show the value of real world data, and highlights the need for further work to facilitate earlier diagnosis of lung cancer in Europe.