30-day mortality after the start of systemic anticancer therapy for lung cancer: is it really a useful performance indicator?

Abstract

Systemic treatment is the standard treatment for unresectable stage III and IV lung cancer. Nevertheless, a 5–10% death rate has been described within 30 days after the last systemic treatment, suggesting that these patient did not benefit. We analysed the 30-day mortality after start of systemic therapy. Data were retrieved from the Netherlands National Cancer Registry. From 2010 to 2015, 26 277 patients were included. 56% were men. The median age was 65 years and 31% of patients were aged ≥70 years. 27% involved small cell lung cancer and 73% nonsmall cell lung cancer. Overall mortality within 30 days after the start of systemic treatment was 6.2%. Multivariable analysis established the prognostic influence of age, histology, number of metastatic sites and type of systemic treatment. Chemotherapy was administered in 77 hospitals, treating each 15–161 lung cancer patients with systemic therapy annually. None of the hospitals had a significantly higher 30-day mortality according to hierarchical multivariable analysis, controlling for case-mix. In the Netherlands, the 30-day mortality rate after start of systemic therapy for lung cancer patients was comparable with earlier reports. Hospital volume did not influence the 30-day mortality rate. 30-day mortality rate is not a meaningful indicator to monitor quality of care.