This annual report from the Norwegian Lung Cancer Registry is based on data collected by the Cancer Registry of Norway (CRN). Data sources include both individual reports from clinicians, pathologists as well as data from other national registries. All patients diagnosed with, treated for, or who deceased from lung cancer in the year 2021 are included. 98,6 % of all Norwegian cancer patients are registered at the CRN.
In 2021 the incidence of lung cancer was declining for every age group in both sexes (Figure 3.1). However, the number of patients diagnosed with lung cancer reached its highest level ever (Figure 3.2). This is due to an increasing number of citizens and an ageing population. An equal number of men and women were diagnosed in 2021. The survival rate has never been better, with a 5-year relative survival rate of 32,5 % for women and 25,6 % for men (Figure 3.21). As a result, the prevalence of lung cancer patients still alive is increasing fast. This increase in prevalence holds for the early post-diagnosis years, as well as for patients living beyond five years (Figure 3.3). In both 2020 and 2021 Covid-19 was highly present in Norway. As shown in figure 3.4 and 3.5, there was no obvious impact on the number of new lung cancer cases diagnosed. A follow up, with a more in depth examination of the data is, however, necessary to reach a conclusion.
The CRN received cTNM information on 91,8 % of all lung cancer patients (Figure 1.1), an impressive number as this is information reported by clinicians on electronic forms that are separate from the electronic patient journal. The cTNM data shows that 26,4 % of lung cancer patients are in stage I when diagnosed, and 44,7 % are in stage IV. Stage II and III make up 7,5 % and 18,7 % respectively (Table 3.1). The concordance between cTNM and pTNM was low, only 40,7 % when comparing all stages (Table 3.2), and 72,9 % when comparing the four main stages (Figure 3.7).
In 2021 the proportion of potentially curable patients (stages I–III and ECOG 0–2) assessed at a multidisciplinary team meeting was 92,6 %. This is close to the national target set at 95 % (Figure 3.8). In the same patient group, 91,5 % received a PET-CT scan as part of their diagnostic work-up. Again this is close to the national target set at 95 % (Figure 3.9). However, the figures 3.8 and 3.9 show some variation between hospitals. Only 36,0 % of patients in stages IB–III had an EBUS investigation performed (Figure 3.10). This is a new figure and a national target for this should be set in the future. The overall proportion of lung cancer patients being treated with curative intent was 38,8 % (Figure 3.11). In this report, curative treatment is defined as either surgery, stereotactic body radiation, or traditional radiotherapy administered in curative doses (as part of chemoradiotherapy). This is a stable result that has been seen over the recent years. The numbers differ slightly between hospitals.
The use of video assisted thoracic surgery is 80,9 % for patients in stage I. The use of robot assisted surgery is increasing, reaching nearly 100 % at one surgical center (Figure 3.13). The quality of surgery is high, with a postoperative mortality rate (30 days) in 2021 of 0,6 % on the national level (Figure 3.14). This is better than the annual average of 1,0 % seen for the 5-year year period 2017–2021. Regarding medical treatment, the data is still incomplete, as only 90 % of the country’s hospitals have systems that automatically report to the CRN. Still, the data received show that the use of immune oncology treatment is increasing at the same levels in different parts of Norway (Figure 3.15). This indicates that there is a homogeneity in the availability of modern treatment options.
The Norwegian Lung Cancer Registry has seen a large increase in reporting over the past years. The reporting on conducted surgery was 100,0 %, and the reporting on pre-treatment investigations was 91,8 % in 2021. Even though the reporting rates are very good, some hospitals submit the reports long after the actual procedures were performed. This may undermine the quality of the reports. Figure 5.2 shows the delay in reporting for each hospital, and only 42,9 % of reports are received at the CRN within 14 days of the multidisciplinary team meeting in which treatment was decided. The national target for this is set as high as 80 % to highlight the importance of fresh data.