30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study.
Level 3 - non-randomized controlled study
National population-based retrospective observational cohort study.
PubMed 27599138 · doi:10.1016/S1470-2045(16)30383-7
What was done
Researchers evaluated national 30-day mortality benchmarks following systemic anticancer therapy (SACT) using Public Health England's SACT dataset. The cohort comprised English residents aged 24 years or older with breast cancer or non-small cell lung cancer (NSCLC) who initiated a SACT cycle in 2014. Multivariable logistic regression examined associations between 30-day mortality after the most recent treatment cycle and patient-, tumour-, and treatment-related factors. Hospital trust variation was evaluated using funnel plots contrasting 30-day mortality against patient volume.
What was found
The analysis evaluated 23,228 breast cancer patients and 9,634 NSCLC patients. 30-day mortality increased with age for curative treatment (breast curative: OR 1.085, 99% CI 1.040-1.132, p<0.0001; NSCLC curative: OR 1.045, 99% CI 1.013-1.079, p=0.00033) and decreased with age for palliative treatment (breast palliative: OR 0.987, 99% CI 0.977-0.996, p=0.00034; NSCLC palliative: OR 0.987, 99% CI 0.976-0.998, p=0.0015). Mortality was significantly higher during the first reported SACT cycle compared with previous cycles (breast palliative: OR 2.326, 99% CI 1.634-3.312, p<0.0001; NSCLC curative: OR 3.371, 99% CI 1.554-7.316, p<0.0001; NSCLC palliative: OR 2.667, 99% CI 2.109-3.373, p<0.0001). Worse general wellbeing (performance status 2-4 vs generally well) was strongly associated with mortality (breast curative: OR 6.057, 99% CI 1.333-27.513, p=0.0021; breast palliative: OR 6.241, 99% CI 4.180-9.319, p<0.0001; NSCLC palliative: OR 3.384, 99% CI 2.276-5.032, p<0.0001). Trusts exceeding 95% control limits included 7 for curative breast, 4 for palliative breast, 5 for curative NSCLC, and 7 for palliative NSCLC.
Why it matters
This study provides national real-world benchmarks for early mortality after systemic anticancer therapy. Identifying key risk factors and outlier hospitals helps clinicians weigh treatment harms versus benefits and guides targeted clinical audit.
Limits
The study is observational and limited to routine administrative dataset records from 2014, with potential unmeasured confounding and variable data quality across trusts. Specific causes of death (cancer progression vs treatment toxicity) are not reported in the abstract. Patients under 24 years of age and other cancer types were not evaluated.
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