Exploring Lung cancer in urban Johannesburg: Risk factors, Clinical presentations, Treatment Modalities, and Patient Outcomes

Background Lung cancer is a leading cause of mortality worldwide, yet limited data are available for South Africa. We aimed to describe the socio-demographic, risk factors, clinical characteristics, treatment modalities, and overall survival of lung cancer patients at two public hospitals in Johannesburg, South Africa. Methods This prospective cohort study included patients newly diagnosed with primary lung cancer enrolled in the Bristol Myers Squibb Foundation Chronic Respiratory Diseases study at Chris Hani Baragwanath Academic Hospital and Helen Joseph Hospital from 1 June 2018 to 31 May 2021. Patient characteristics were analyzed by age (≤ 60 vs. >60 years), and multivariable Cox proportional hazard models assessed the impact of age and histology on survival. Results Among 236 patients, 41.5% were aged ≤ 60 years, and 58.5% were > 60 years. Most were male (69.5%), of Black African descent (66.1%), and smokers (80.5%). Non-small cell lung cancer (NSCLC) was the most common histology (89.0%), and 69.3% presented with stage 4 disease. Patients > 60 years were more likely to be female (61.6% vs. 19.4%, p = 0.002), hypertensive (45.1% vs. 18.9%, p < 0.001), diabetic (10.4% vs. 3.2%, p = 0.038), HIV-negative (91.7% vs. 68.1%, p < 0.001), and diagnosed with small cell lung cancer (15.5% vs. 5.3%, p = 0.048). Survival rates were 39.0% at 6 months and 22.0% at 12 months, with poorer outcomes in patients > 60 years (6-month: 37.6% vs. 40.7%; 12-month: 16.6% vs. 28.8%, p = 0.021). Histological subtype did not impact survival (p = 0.088). Predictors of overall survival were associated with ECOG 2–4 [Adjusted HR (aHR): 1.62, p = 0.029], diabetes [aHR: 2.37, p = 0.013], and palliative care referral [aHR: 2.60, p = 0.006], while chemotherapy was protective [aHR: 0.46, p = 0.004]. Conclusion This study highlights the poor survival outcomes for lung cancer patients in South Africa, emphasizing the need for targeted interventions to improve early diagnosis.