Comparative study of lung cancer care and survival outcomes across the Nordic countries

Background: Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. Despite societal, economic and genetic similarities, 5-year age-standardized relative survival rate is lower in Finland compared to the other Nordic countries. Previous studies have identified discrepancies in LC guidelines, but research on actual care practices remains limited. We aim to address this knowledge gap by conducting a comprehensive examination of the current care practices for LC patients in the Nordic countries. Methods: We employed a non-interventional, prospective study design. We conducted an expert workshop involving LC specialists from Finland to formulate relevant questions for a structured survey. This survey was distributed to healthcare professionals (HCPs) across Nordic hospitals and primary care units. The survey results were then analyzed, and a follow-up Nordic LC expert workshop was held to identify the most relevant factors potentially influencing LC survival outcomes. Results: Four key differences in care practices between Finland and other Nordic countries were identified: (1) resources available in primary care units, (2) waiting times in primary care, (3) availability of novel treatments and (4) tracking of LC survival and mortality outcomes by the hospital. Finland has the lowest access to computed tomography (CT) from primary care, longest waiting times in primary care, and lacks a national outcome tracking system. Some medical doctors in Finland and Iceland highlighted observed limitations in specific cases involving access to neoadjuvant immunotherapy and chemotherapy. Interpretation: Several factors unrelated to specialized LC care are likely contributing to poorer 5-year survival rates for LC in Finland. These findings may be applicable to other healthcare systems as well.