Association between Receipt of Guideline-Concordant Lung Cancer Treatment and Individual- and Area-Level Factors: A Spatio-Temporal Analysis

Abstract

Background: Guideline-concordant treatment (GCT) of lung cancer has been observed to vary across geographic regions over the years. However, there is little evidence as to what extent this variation is explained by differences in patients' clinical characteristics versus contextual factors, including socioeconomic inequalities. Methods: This study evaluated the independent effects of individual- and area-level risk factors on geographic and temporal variation in receipt of GCT among patients with lung cancer. Receipt of GCT was defined on the basis of the National Comprehensive Cancer Network guidelines. We used Bayesian spatial-temporal multilevel models to combine individual and areal predictors and outcomes while accounting for geographically structured and unstructured correlation and linear and nonlinear trends. Results: Our study included 4,854 non–small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases, reported to the Victorian Lung Cancer Registry between 2011 and 2018. Area-level data comprised socioeconomic disadvantage and remoteness data at the local government area level in Victoria, Australia. Around 60.36% of patients received GCT, and the rates varied across geographic areas over time. This variation was mainly associated with poor performance status, advanced clinical stages, NSCLC types, public hospital insurance, area-level deprivation, and comorbidities. Conclusions: This study highlights the need to address disparities in receipt of GCT among patients with lung cancer with poor performance status, NSCLC, advanced clinical stage, stage I–III SCLC, stage III NSCLC, public hospital insurance, and comorbidities, and living in socioeconomically disadvantaged areas. Impact: Two-year mortality outcomes significantly improved with GCT. Interventions aimed at reducing these inequalities could help to improve lung cancer outcomes.

Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021

“…Australian and international data indicate wide variances in care between centres even in standard, established therapies 6. Data from two states in Australia (Victoria and New South Wales) consistently demonstrate similar findings: variations in care and outcomes between Indigenous and non-Indigenous Australians, rural and metropolitan patients, public and private centres and those of differing socioeconomic status 7 8. At least some of these variations result from differing infrastructure to investigate and treat lung cancer across Australia’s hospitals.…”

Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper

“…A study of 4854 Victorian NSCLC and SCLC patients revealed guideline concordant treatment delivered to just 60.36% of patients with variation across geographic areas and over time associated with poor performance status, advanced clinical stages, NSCLC subtypes, public hospital insurance, area-level deprivation and comorbidities. 17 18 Regional variation in 2-year mortality for NSCLC has been demonstrated where those with timely first definitive treatment (OR 0.73; 95% CI 0.56 to 0.94) and multidisciplinary meeting presentation (OR 0.74; 95% CI 0.59 to 0.93) were significantly less likely to die within 2 years of diagnosis. 19 Variation in processes of care is evident in timeliness of care, 20–22 pathological confirmation of diagnosis, 23 utilisation of multidisciplinary meetings 23 24 ( figure 2 ), patterns of care delivery 25–28 and follow-up after cancer treatment.…”

“…Braithwaite et al describe the 60:30:10 phenomenon in modern medical care where on average 60% of care is in line with evidence or consensus-based guidelines (confirmed in Victorian lung cancer 17 ), 30% represents some form of waste or low value care and 10% of care leads to patient harm. 75 The ability to improve evidence-based best practice, to reduce low value care and to minimise patient harm provides three clear improvement objectives and demands performance measurement, reporting and data availability for knowledge translation, and improvement in quality and value of delivered care.…”

“…There is substantial institutional and regional evidence of unwarranted variation in both processes of care and outcomes for Australians diagnosed with lung cancer (figure 1). A study of 4854 Victorian NSCLC and SCLC patients revealed guideline concordant treatment delivered to just 60.36% of patients with variation across geographic areas and over time associated with poor performance status, advanced clinical stages, NSCLC subtypes, public hospital insurance, area-level deprivation and comorbidities 17 18. Regional variation in 2-year mortality for NSCLC has been demonstrated where those with timely first definitive treatment (OR 0.73; 95% CI 0.56 to 0.94) and multidisciplinary meeting presentation (OR 0.74; 95% CI 0.59 to 0.93) were significantly less likely to die within 2 years of diagnosis 19.…”

“…Variation in processes of care is evident in timeliness of care,20–22 pathological confirmation of diagnosis,23 utilisation of multidisciplinary meetings23 24 (figure 2), patterns of care delivery25–28 and follow-up after cancer treatment 29. Substantial variation is also evident in key outcomes of care including the utilisation of active anticancer treatment17 23 30–32 and survival 19 32 33…”