Geographical inequalities in lung cancer management and survival in South East England: evidence of variation in access to oncology services?

Abstract

This study aimed to determine whether the management and survival of patients with lung cancer varied among 26 health authorities in South East England. The Thames Cancer Registry identified patients diagnosed with lung cancer (ICD-10 codes C33 -C34) between 1995 and 1999. After excluding death certificate only patients, 32 818 (81%) patients were analysed. The proportions of patients receiving active treatment varied among health authorities between 5 and 17% for non-investigative surgery, 4 and 17% for any chemotherapy, 8 and 30% for any radiotherapy and 15 and 42% for any active treatment. One-year patient survival ranged from 11 to 34%. There was evidence of health authority level variation even after adjusting for case mix. Patients whose first hospital attendance was at a radiotherapy centre were more likely to receive active treatment (OR 1.72, 95% CI 1.21 -2.46), chemotherapy (1.38, 1.06 -1.79) or radiotherapy (1.86, 1.28 -2.71). There was some evidence that patients whose first hospital attendance was at a radiotherapy centre survived longer. This study shows there is geographical inequality in the treatment given to lung cancer patients and patient survival in South East England. There was some evidence to suggest that these inequalities might be explained by variations in access to oncology services. Future studies should investigate the pathways and barriers to specialist care in this condition.

Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military

“…24 Racial/ethnic differences in genetics, tumor histology, and access to care may explain the variation in survival. 10,24,26 The unadjusted median overall survival rates for Caucasians and African Americans were similar (14 vs. 16 months), and the lack of significant outcome disparity was confirmed in the multivariable survival model. Our findings are consistent with a previous study performed at the Walter Reed Medical Center documenting a lack of difference in survival between African Americans and Caucasians.…”

“…27 Taken together, these data support the theory that poorer outcomes seen in civilian African Americans are more likely related to quality healthcare access rather than tumor biology. 10,26 Moreover, our cohort was diagnosed at a younger age and with a higher proportion of early stage disease; specifically, stage I. This differs from the general US civilian population, where the average age at diagnosis is 70 years with a small percentage (17 %) diagnosed at the localized stage.…”

Variation in treatment and outcome in patients with non-small cell lung cancer by region, hospital type and volume in the Netherlands

“…Several patient factors are associated with lower odds of undergoing a potentially curative treatment for lung cancer. Higher age is the most important factor, but in studies from the United States as well as Europe gender, comorbidity, race, socio-economic status, region or country of origin have also proven to be predictive (17)(18)(19)(20)(21)(22). These inequalities are not only due to decreased access to care, but also differences in physicians' treatment choices and differences in guideline implementation and adherence are believed to be of influence.…”

An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer

“…For example, in Scotland, the median survival for patients with NSCLC is approximately 5 months (Gregor et al, 2001). Therefore, it is important to ensure that the treatment of these patients is optimal and that active treatment is offered to all patients who may benefit (Gregor et al, 2001;Jack et al, 2003).…”