Treatment pathways of non-small cells lung cancer patients in the Czech Republic: an insight 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.

Methods

This was a longitudinal, historical descriptive cohort study spanning from 2017 to 2022. The index date was determined by the first bronchoscopy (BX) followed by histopathological (HP) examination, alongside the presence of the ICD-10 diagnosis code C34. Incident patients aged ≥18 years were included if they had no prior malignancy reported in the data. Pharmacotherapies (PHT), including chemotherapy (CT), precision therapy (IOTT), as well as surgery (SX) and radiotherapy (RT), were investigated concerning overall survival. Additionally, the presence of a reported multidisciplinary team (MDT) and treatment at a Complex Oncological Center (COC) with high-load experience was considered.

Results

By using administrative claim data we analyzed the pathways of 16,783 NSCLC patients with the aim to provide a clear depiction of the current state of care. Less than 40% (38.4%) of patients had MDT reported within a median of 21 days. Of the 12,803 treated patients,, 47.42% received CT, 27.56% underwent SX, 1.4% underwent RT, and 5.32% IOTT. Early initiation of treatment within 4 weeks from BX was identified in only 20% of SX patients, 24% of patients treated with CT, and 26% of RT patients. The centralization of care in COCs primarily concerned SX and CT_NEO, while 24% of patients indicated to CT were treated elsewhere. The OS rate of those treated was 31% in median, 64.3% in SX patients, and 14% in those treated with CT. The prognosis of patients was positively affected by COCs.

Conclusions

We developed a methodology for administrative data processing which can be implemented as a technical infrastructure to fulfill the organization and quality evaluation of cancer care in the Czech Republic.

KEY MESSAGES

• There is limited evidence regarding the effects of patient pathways used in oncological care. However, there is a need for the integration of innovative approaches to advance cancer control.

• We have developed a methodology for processing administrative data that can be implemented alongside the Czech National Cancer Registry to create a comprehensive dataset including histopathological characteristics, disease stages, and reimbursement care data.

• A comprehensive Information and Communications Technology model, integrating multiple data sources, has been prepared to facilitate the organization and quality evaluation of cancer care in the Czech Republic.