Head of PHARMO Research PHARMO Institute for Drug Outcomes Research Utrecht, Netherlands
Background: The development of drugs for lung cancer is rapid, with new compounds entering the market at an ever-increasing pace. This is positive for patients, but monitoring the long-term safety of these agents in real-world clinical practice is pivotal.
Objectives: To explore the availability of PHARMO data for studies of characteristics, treatment pathways and ultimately safety in patients with lung cancer in real-world clinical practice in the Netherlands.
Methods: This cohort study used hospital, in-patient and out-patient data from the PHARMO Data Network. All patients with a diagnosis of lung cancer from 2017-2019 from the hospital admissions or ambulatory consultations were selected. The index date was defined as the first date of lung cancer diagnosis during the study period. Patients with < 12 months of data history prior to the index date or a diagnosis of lung cancer in the 12 months prior to the index date were excluded. Patient characteristics at index date and treatment pathways during follow-up were determined. Due to lack of geographical overlap, information for treatment pathways of chemotherapy was available for a subset. Descriptive statistics were used for all analyses.
Results: After applying all in- and exclusion criteria, 8,480 incident lung cancer patients were included. Median age was 70 years and 54% was male. Type and stage of lung cancer was unknown for about three-quarters of patients. Co-medication and co-morbidities/complications could be mapped through the pharmacy and hospital data. Information on smoking, body mass index (BMI), blood pressure and estimated glomerular filtration rate (eGFR) was not available for the majority of patients. For 55% no surgery, radiotherapy, chemotherapy, targeted therapy or immunotherapy was observed during follow-up. For patients included in the subset (n = 2,890), the most commonly observed initial treatment was chemotherapy (60%), followed by immunotherapy (14%). Among patients who received chemotherapy, no clear treatment pattern was observed with an average follow-up of 1 year. About 50% received 2 treatment lines and one-third received 3 lines.
Conclusions: This study shows that the established links between PHARMO and Netherlands Cancer Registry (NCR) and/or Pathology Registry (PALGA) are essential to map characteristics of lung cancer (e.g. type and stage). By using these established links and more geographical overlap of information of chemotherapy PHARMO data is a valid source for monitoring the use and studying the (long-term) safety of new compounds. The short exposure of these compounds is a challenge which complicates studying the (long-term) safety.
