In a systematic review and meta-analysis, Lynne Forrest and colleagues find that patients with lung cancer who are more socioeconomically deprived are less likely to receive surgical treatment, chemotherapy, or any type of treatment combined, compared with patients who are more socioeconomically well off, regardless of cancer stage or type of health care system.

Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival.This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. MEDLINE, EMBASE and CINAHL databases were searched to locate cohort studies of adults with a primary diagnosis of lung cancer, where the outcome was stage at diagnosis or the length of time spent within an interval on the care pathway, or a suitable proxy measure, analysed according to a measure of socio-economic position. Meta-analysis was undertaken when there were studies available with suitable data.Of the 461 records screened, 39 papers were included in the review (20 from the UK) and seven in a final meta-analysis for stage at diagnosis. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared to the least, deprived group (odds ratio=1.04, 95%Correspondence to Dr Lynne Forrest, Administrative Data Research Centre Scotland, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX, UK Lynne.Forrest@ed.ac.uk tel +44 131 651 7844. Systematic review registration: PROSPERO CRD42014007145 Competing InterestsWe declare that we have no competing interests. Authors' ContributionsLF: conception and design, data collection and analysis, manuscript writing and final approval of the manuscript. JA, MW, GR: design, critical revision and final approval of the manuscript. SS: design, data collection and analysis, critical revision and final approval of the manuscript. Europe PMC Funders GroupAuthor Manuscript Thorax. Author manuscript; available in PMC 2017 May 01.Published in final edited form as: Thorax. 2017 May ; 72(5): 430-436. doi:10.1136/thoraxjnl-2016 Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts confidence interval = 0.92 to 1.19). No socio-economic inequalities in the patient interval or in time from diagnosis to treatment were found.Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer.

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