Treatment pathways of lung cancer patients in the Czech Republic: insights from administrative claims data

INTRODUCTION: A patient pathway is an evidence-based tool that details the phases of care with the aim of increasing the effectiveness and efficiency of patient care. We describe diagnostic and treatment pathways and related overall survival (OS) of non-small cell lung cancer patients. METHODS: This was a longitudinal, historical descriptive cohort study based on administrative claim data, spanning from 2017 to 2022. The index date was determined by the first bronchoscopy with lung biopsy (BX) followed by histopathological (HP) examination, alongside the presence of the International Classification of Diseases 10th revision diagnosis code C34. Incident patients aged ≥18 without prior malignancy. Pharmacotherapies (PHT), including chemotherapy (PHT_CT), precision therapy (PHT_IOTT), as well as surgery (SX) and radiotherapy (RT), were investigated associated with OS. A presence of multidisciplinary team (MDT) and treatment at a Complex Oncological Center (COC) with high-load experience was considered. RESULTS: We analysed 5819 patient pathways. Less than half (45.6%) of patients had MDT reported within a median of 20 days. Of the 4417 patients treated, 30% underwent more than one BX, 47.7% received PHT_CT, 25.9% underwent SX, 16.4% underwent RT and 9.08% PHT_IOTT. Early initiation of treatment within 4 weeks from BX was identified in 21% of SX patients, 30% of patients treated with PHT_CT and 23% of RT patients. The centralisation of care in COCs primarily concerned SX and PHT_IOTT, while 33% of patients indicated to PHT_CT were treated elsewhere. The median OS reached approximately 16 months in the overall population, 21 months in the verified treated cohort and 13 months in patients treated with PHT_CT, while it was not reached in patients treated with SX. We observed a positive association between patient prognosis and treatment centralisation in COCs. CONCLUSIONS: This methodology can be implemented as a technical infrastructure to fulfil the organisation and quality evaluation routines in cancer care, largely based on administrative data.