¹Cancer Registry Saxony-Anhalt, Magdeburg, Germany

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Background: Over the past two decades, numerous targeted therapies (TT) have been integrated into routine non-small-cell lung cancer (NSCLC) treatment in Germany. This study aims to assess regional disparities in the utilization of TT for NSCLC in Saxony-Anhalt using cancer registry data.

Materials and Methods: Cancer registry in Saxony-Anhalt collects data on all curative and palliative systemic treatments. TT were identified according to the ENCR recommendations on recording treatment data [1] and classified according to the Anatomical Therapeutic Chemical Classification System levels [2]. Rural areas were defined as counties with a low urbanity index of the Central Research Institute of Ambulatory Health Care (Zi) [3].

Results: This study included 13,379 NSCLC patients from rural areas and 4,504 from urban areas, diagnosed between 2010 and 2023. From 2010 to 2014, epidermal growth factor receptor tyrosine kinase inhibitors (N=192, 35%) and vascular endothelial growth factor inhibitors (N=179, 33%) were the most commonly used TT. Programmed cell death protein 1/death ligand 1 inhibitors were the most commonly used TT group from 2015 to 2019 (N=1,625, 62%), and this increase continued from 2020 to 2023 (N=2,253, 81%). Overall, the utilization of TT increased over time, with an increase observed both for patients residing in rural areas (2010-2014: 10%, 2015-2019: 41%, 2020-2023: 50%) and in urban areas (2010-2014: 9%, 2015-2019: 38%, 2020-2023: 41%). Similar disparities were observed in both early-stage (UICC I-III: urban: 17% vs. rural: 23%) and advanced NSCLC (UICC IV: urban: 45% vs. rural: 53%).

Conclusion: Despite concerns regarding healthcare access in rural areas, the utilization TT for NSCLC in Saxony-Anhalt has increased over time, in both rural and urban areas. The present study demonstrates that cancer registry data is a valuable resource for conducting drug utilization studies in Germany. Future research should examine referral patterns between regions and clinical centers and treatment timeliness to better understand TT utilization trends.

Literatur

[1] European Network of Cancer Registries (ENCR). ENCR Recommendation: Treatment Data Recording (phase I). 2025 [accessed 2025 Sep 9]. Available from: https://encr.eu/sites/default/files/Recommendations/ENCR-Recommendation_Treatment_EN_Jan2025.pdf
[2] WHO Collaborating Centre for Drug Statistics Methodology (WHOCC). ATC/DDD Index 2025. [accessed 2025 Sep 9]. Available from: https://atcddd.fhi.no/atc_ddd_index/
[3] Schulz M, Hoebel J, Lampert T, et al. Korrelation zwischen räumlichen Sozialstrukturfaktoren und Indikatoren des medizinischen Versorgungsbedarfs. Das Gesundheitswesen. 2015;78(5):290-7. DOI: 10.1055/s-0034-1396888