Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study

Abstract

Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.

Impact on survival of modelling increased surgical resection rates in patients with non-small-cell lung cancer and cardiovascular comorbidities: a VICORI study

“…A recent study investigated the association between age, deprivation and CVD comorbid conditions and NSCLC resection in England and found strong evidence that comorbidities reduced the receipt of surgery in early-stage patients, 22 which agrees with our study. However, using the multi-state framework to model the patient care pathway allowed us not only to report survival for resected and non-resected patients, but also investigate how increasing resection rates affects survival.…”

“…First, we were unable to include WHO performance status classification due to high proportion of patients with missing values, which has been shown to be associated with resection rates. 22 Second, smoking status is unavailable, which is likely to be associated with CVD comorbidity (particularly COPD) and resection rate, but IMD may be a suitable proxy for some health and lifestyle choices. Third, we could only identify CVD comorbidity for NSCLC patients with a previous hospital admission because we used the in-patient HES dataset, extracted directly from individual hospital patient administration systems, and missed patients who never had a hospital admission over the time period of our study.…”

Comorbidity prevalence among cancer patients: a population-based cohort study of four cancers

“…Patients with comorbidity may be less likely than those without comorbidity to receive curative treatment [3]. Treatment decisions made by clinicians may be weighted by the type and severity of comorbidity, for example, CHF has been reported to influence receipt of surgery for non-small cell lung cancer [46], receipt of adjuvant chemotherapy for colon cancer [47] and receipt of any treatment for prostate cancer [48]. The presence of COPD influenced receipt of surgical treatment in non-small cell lung cancer patients [46] and adjuvant therapy in colon cancer patients [47].…”

“…Treatment decisions made by clinicians may be weighted by the type and severity of comorbidity, for example, CHF has been reported to influence receipt of surgery for non-small cell lung cancer [46], receipt of adjuvant chemotherapy for colon cancer [47] and receipt of any treatment for prostate cancer [48]. The presence of COPD influenced receipt of surgical treatment in non-small cell lung cancer patients [46] and adjuvant therapy in colon cancer patients [47]. However, there is also evidence that comorbid patients who receive treatment have better prognosis for survival than those who do not receive treatment, as shown with the receipt of adjuvant therapy for colon cancer [47,49].…”

Socioeconomic deprivation and inequalities in lung cancer: time to delve deeper?

“…In lung cancer specifically, this may reflect differences in treatment rates and, even without the specific effects of socioeconomic variation, there are geographical variations in lung cancer treatment rates, attributed by some to varying practice between multidisciplinary teams (MDT) 6. In this issue of Thorax , Belot et al 7 add to the growing body of evidence that the higher the level of deprivation, the less likely people are to have surgery for lung cancer. The focus of the study is factors affecting surgical resection which is described as ‘major’ but is assumed to be equivalent to surgery with curative intent.…”