Lung Cancer Policy and Evaluation

Predictive models of lung cancer and tobacco smoking are a major focus of the lung cancer research stream. The team’s models are at various stages of development and include: a natural history microsimulation model of lung cancer, a cumulative lifetime risk model of lung cancer mortality, a macrosimulation model of all cancers and diseases caused by smoking, a forecasting model of Australian smoking behaviour, and a discrete event simulation model of lung cancer survival and treatment costs. Each model can address unique scientific and policy-relevant questions, and the outcomes of each model can be used to interchangeably to maximise gains in lung cancer and tobacco control.

Lung cancer screening represents an opportunity to save the lives of thousands of high-risk current and ex-smokers. The team is involved in a NHMRC-funded lung cancer screening trial being conducted in Australia, Canada, and Hong Kong: The International Lung Screen Trial (ILST) by led by Prof Kwun Fong at the University of Queensland (NCT02871856). The aim of the research is to model the trial outcomes to optimise the benefits to harms ratio, and cost-effectiveness of lung cancer screening in the Australian setting. Preliminary trial results from the ILST, as well as an evidence review and assessment of lung cancer risk factors conducted by the team, were included in Cancer Australia’s enquiry into the prospects, process and delivery of a national lung cancer screening program in Australia. The researchers are co-investigators on an NHMRC-funded project investigating barriers and facilitators to lung cancer screening implementation being led by Dr Nicole Rankin at the University of Sydney (#1185390).

Up to 85% of lung cancers in men and 70% of lung cancers in women are caused by smoking in Australia. The team is supporting national tobacco control initiatives with local evidence. Work in this area includes quantifying contemporary risk estimates for tobacco related disease in the 45 and Up Study, using simulation models to predict changes in population smoking behaviours in relation to existing and hypothetical tobacco control changes/interventions, and using statistical and simulation models to estimate the long-term impact on tobacco related diseases. The models can also be used to evaluate the long-term impacts of new tobacco interventions undergoing trial evaluation. The researchers are also partner investigators on a NHMRC-funded trial on improving outcomes for cancer patients who smoke, led by Prof Chris Paul at the University of Newcastle (G1800883/G1801070).

There are many promising new drugs for people with lung cancer, both in the market and in development, that can extend and improve life. Using data from the 45 and Up Study and simulation modelling, the team is investigating the patterns of care and uptake of these new therapies for people with lung cancer.

Around 30% of lung cancers in women, and 15% among men in Australia are diagnosed in life-long non-smokers (‘never smokers’). The causes of lung cancer in never-smokers are not well known and the team is investigating potential risk factors associated with this disease in large international cohort studies.