A matter of survival

No matter what country you call home, lung cancer is a grim diagnosis—but it’s worse in England. Epidemiologists have known since the early 2000s that English people with lung cancer die sooner than patients in other European countries. But it hasn’t been clear what accounts for these differences, so Yale medicine and epidemiology professor Cary Gross teamed up with British and Italian colleagues to take a closer look. They examined American and British databases of elders who had had non-small cell lung cancer in a recent four-year period.

At every step, they found, English patients’ lung cancers get less attention than US patients’ do. They are diagnosed later. Cases are less often confirmed via biopsy or categorized into a stage. British patients get less chemotherapy, radiation, and surgery than their American counterparts. One-year survival in the UK is 29 percent; here, it’s 40 percent.

The differences are encapsulated in a ratio: for every 1,000 elderly English lung-cancer patients, 246 survive to the two-year mark, compared with 344 in the United States—98 more deaths. (The results appeared online in Journal of Thoracic Oncology.) The study wasn’t designed to uncover the reasons behind these disparities, but the researchers have some guesses. Coauthor Mick Peake of University College London wrote in an e-mail that, in the United States, “culturally people are more likely to demand or accept a radical treatment whereas in the UK many older people take a more fatalistic view.”

The US system also includes financial incentives to test and treat, Gross says. While that can result in over-treatment, “on the other hand, it can facilitate access to treatment.”