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Health policy
Original research
Lung cancer survival and mortality in Taiwan following the initial launch of targeted therapies: an interrupted time series study
  1. Jason C Hsu1,
  2. Chen-Fang Wei2,
  3. Szu-Chun Yang3,
  4. Peng-Chan Lin3,
  5. Yang-Cheng Lee4,
  6. Christine Y Lu5
  1. 1International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
  2. 2Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
  3. 3Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  4. 4Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
  5. 5Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
  1. Correspondence to Dr Jason C Hsu; jasonhsu{at}tmu.edu.tw

Abstract

Objectives Two oral targeted therapies, gefitinib and erlotinib, were first approved and then launched into the market for treatment of late-stage non-small cell lung cancer (NSCLC) in Taiwan in 2003 and 2006, respectively. The aim of this study were to determine the trends in lung cancer burden and examine changes in lung cancer-related survival rates and mortality following the launch of these new drugs.

Setting Yearly lung cancer-related data (1994–2013), including incidence, number of newly diagnosed patients, survival rate and mortality, were retrieved from the Taiwan Cancer Registry Database.

Design and outcome measures Using a time series design with autoregressive integrated moving average model, we investigated and projected trends in the incidence and early diagnosis of lung cancer in Taiwan. We also estimated the changes in survival rates and mortality following the launch of targeted therapies using interrupted time series and segmented regression models.

Results The age-standardised incidence of lung cancer increased from 22.53 per 100 000 people in 1994 to 34.09 in 2013, and it was projected to reach 38.98 by 2020. The rate of early-stage NSCLC at diagnosis increased from 12.63% in 2004 to 23.99% in 2013, and it was projected to reach 32.95% by 2020. The 2-year lung cancer survival increased by 19.81% (95% CI 14.90% to 24.71%) 3 years following the launch of gefitinib. Lung cancer mortality declined by 5.97% (95% CI −8.20% to −3.73%) 3 years following the launch of gefitinib.

Conclusions Lung cancer survival rate increased and mortality decreased significantly following the launch of gefitinib and erlotinib in Taiwan.

  • targeted therapies
  • lung cancer
  • incidence
  • survival rate
  • mortality
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-033427

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    Footnotes

    • Contributors JCH, CFW and SCY conceptualised and designed the study. PCL and YCL provided suggestions for the research design from a clinical perspective. CFW collected data, performed the analyses and drafted the manuscript. JCH and CYL reviewed all data and revised the manuscript critically for intellectual content. All authors approved the final version for submission.

    • Funding This work was supported by Taiwan Ministry of Science and Technology grants (grant numbers: MOST 104-2320-B-006-005, MOST 106-2320-B-006-039).

    • Disclaimer The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Use of data from the online Taiwan Cancer Registry Database for research purposes is exempt from review by the Institutional Review Board in Taiwan because the data used are public and aggregated population-level information.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article. The authors obtained nationwide data from 1994 to 2013 (20 years) related to the lung cancer incidence in Taiwan from the Taiwan Cancer Registry Database, compiled by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan.