EP1.12-02 SCLC Treatment Uptake and Survival Outcomes: A 2-Year Comparison Between 2 Tertiary Referral Centers in Alberta, Canada

Although the guideline recommend treatment for small cell lung cancer (SCLC) has not changed for several decades, real world evidence on patterns of practice and outcome are scarce. We compared two similar sized cancer care centers in the province of Alberta over a two-year period for experiences with both extensive stage (ES) and limited stage (LS) SCLC diagnoses, treatment and survival outcomes Retrospective analyses were conducted on the clinical data of SCLC patients retrieved from the Glans-Look Lung Cancer database. All SCLC patients diagnosed between 2015 and 2016 at the Tom Baker Cancer Centre (TBCC), Calgary and Cross Cancer Institute (CCI), Edmonton were included. The characteristics of patients seen at the two institutions were compared using the Fisher Exact test. The overall survival (OS) outcome based on guideline recommended 1st and 2nd line SCLC treatments as well as treatment location was estimated with Kaplan Meier survival analysis and multivariate Cox Proportional Hazard model. Between 2015 and 2016, 105 SCLC patients were diagnosed at the TBCC, Calgary and 243 at CCI, Edmonton, Alberta. Patient characteristics were similar for both centers. 66% (69/105) of SCLC were ES at TBCC as opposed to 78% (189/243) in CCI (p = 0.024). Overall, treatment uptake rates in TBCC compared to CCI were as follows: 1st SCLC treatment (chemotherapy, surgery, radiotherapy) rate 88% (92/105) versus 86% (208/243), prophylactic cranial irradiation (PCI) 27% (28/105) vs. 37% (89/243) and 2nd line chemo- and or radio-therapy 33% (35/105) vs. 30% (74/243). 6% (2/36) of LS patients at TBCC compared to 28% (15/54) at CCI had surgery ± adjuvant as their 1st treatment. More ES patients at CCI received chemo & thoracic RT (32 vs.19%, 61/189 and 13/69) as well as PCI (31 vs.16%, 58/189 and 11/69) than those at TBCC. OS at CCI versus TBCC was not statistically different for all SCLC patients (11 vs. 10 months, p = 0.217; HR = 1.278, 95% CI: 0.978 -1.671, p = 0.072) nor when we stratified patients by LS or ES. Despite subtle variation in the uptake of PCI, surgical resection of peripheral LS, management patterns for SCLC patient, including the uptake of second line treatment were consistent between the two geographically separate centers. It is reassuring that similar survival outcomes can be achieved in the real world setting by the adoption of standard practices across a single health administered jurisdiction.