Ontada’s Dr Jessica Paulus on Investigating Secular Trends in Presenting Lung Cancer Stage

At the recent 2024 American Society of Clinical Oncology (ASCO) annual conference, Jessica K. Paulus, ScD, senior director of real-world research, Ontada, a business of McKesson, presented the study findings, “Assessing secular trends in lung cancer stage in the United States community oncology setting from 2013 to 2023.”

In part 1 of our interview with Paulus, also a trained epidemiologist, she explains the rationale for the investigation, and what were the research goals for this analysis, which used data from The US Oncology Network on trends in lung cancer stage when patients present for care.

Transcript

Can you discuss the study behind the data presented at ASCO and what were your primary and secondary outcomes of interest?

The work that we presented at ASCO a week ago or so was really leveraging an impressively large set of real-world data that emanates from The US Oncology Network. Our goal was to research all of that data to investigate time trends, or secular trends, in the stage of lung cancer that patients have when they present for care at The US Oncology Network, which is one of the largest networks for community oncology care in the United States. Our objective was really to leverage this very-large-scale data to describe over the last decade or so the trends in how advanced lung cancer is when patients present for care.

We were looking at both non–small cell lung cancer and small cell lung cancer, and essentially describing trends for each disease individually over the last decade. One of our real motivating principles was that there have been changes in care, as well as global events, over the last decade that could really affect the stage of a patient's disease when they present for care or when they develop symptoms from lung cancer and present for care.

One of those, of course, is the COVID-19 pandemic, which we know had an impact on health care resource utilization and availability in so many health systems, where many health care resources were repurposed to be focused on care for patients with COVID-19 instead of, perhaps, preventive care, resources, or activities or programs. And, of course, also changes in patient behavior around timeliness of seeking screening care because of, again, risk/benefit tradeoffs related to the pandemic. Of course the other thing that has been a huge development and change in lung cancer prevention, in particular, is the US Preventive Services Taskforce guidelines that were launched in 2013, and updated in 2021, regarding the use of low-dose CT scanning for patients or for individuals who are at higher risk for lung cancer—so those are current and former smokers. Given all of these trends, there's reason to be curious about whether there are changes in the stage of cancer for patients who are presenting for care.

You also asked me about outcomes. The outcome for this study was actually the stage of lung cancer for a patient when they present to The US Oncology Network. You'll notice I'm being a little bit careful about saying the “stage of cancer at presentation to the network” rather than “at diagnosis,” and that's because those are really the data that we were focusing on for this study, recognizing that some patients may have been classified with a different stage at true diagnosis if it was outside of the network and they were then changing the site of their care to come to The US Oncology Network after that diagnostic encounter.