Management of stages I and II non‐small‐cell lung cancer in a New Zealand study: divergence from international practice and recommendations

Stevens, Wendy; Stevens, Graham; Kolbe, John; Cox, B.

doi:10.1111/j.1445-5994.2007.01523.x

Cited by 25 publications

(29 citation statements)

References 36 publications

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“…some comorbid conditions may affect or limit treatment options or decisions). In New Zealand, comorbidity has been found to contribute to ethnic-specific survival disparities for colon cancer [12], the management of stages I and II non-small-cell lung cancer [13], and adverse event status, inpatient death and increased length of stay in selected Auckland hospitals [14]. Internationally comorbidity has also been found to adversely affect survival in patients with a range of conditions, including cervical cancer [15-21].…”

Section: Introductionmentioning

confidence: 99%

Does comorbidity explain the ethnic inequalities in cervical cancer survival in New Zealand? A retrospective cohort study

et al. 2011

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BackgroundThere are large ethnic differences in cervical cancer survival in New Zealand that are only partly explained by stage at diagnosis. We investigated the association of comorbidity with cervical cancer survival, and whether comorbidity accounted for the previously observed ethnic differences in survival.MethodsThe study involved 1,594 cervical cancer cases registered during 1994-2005. Comorbidity was measured using hospital events data and was classified using the Elixhauser instrument; effects on survival of individual comorbid conditions from the Elixhauser instrument were also assessed. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs).ResultsComorbidity during the year before diagnosis was associated with cervical cancer-specific survival: those with an Elixhauser count of ≥3 (compared with a count of zero) had a HR of 2.17 (1.32-3.56). The HR per unit of Elixhauser count was 1.25 (1.11-1.40). However, adjustment for the Elixhauser instrument made no difference to the mortality HRs for Māori and Asian women (compared to 'Other' women), and made only a trivial difference to that for Pacific women. In contrast, concurrent adjustment for 12 individual comorbid conditions from the Elixhauser instrument reduced the Māori HR from 1.56 (1.19-2.05) to 1.44 (1.09-1.89), i.e. a reduction in the excess risk of 21%; and reduced the Pacific HR from 1.95 (1.21-3.13) to 1.62 (0.98-2.68), i.e. a reduction in the excess risk of 35%.ConclusionsComorbidity is associated with cervical cancer-specific survival in New Zealand, but accounts for only a moderate proportion of the ethnic differences in survival.

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Section: Introductionmentioning

confidence: 99%

Does comorbidity explain the ethnic inequalities in cervical cancer survival in New Zealand? A retrospective cohort study

et al. 2011

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“…Nine studies (Cuffe et al, 2012;Girones et al, 2012;Grose, Devereux & Milroy, 2011;Haasbeek et al, 2012;Landrum et al, 2012;Ngeow et al, 2010;Stevens, Stevens, Kolbe, & Cox, 2008;Vinod et al, 2008;Wang et al, 2012) relate to this gap. UK guidelines note that age alone should not exclude a patient from surgery as good outcomes have been reported for some older patients .…”

Section: Gap 4: Older Age and Co-morbidities Influence The Use Of Tmentioning

confidence: 99%

“…UK guidelines note that age alone should not exclude a patient from surgery as good outcomes have been reported for some older patients . The under-utilisation of treatment for the elderly is evident in population-based studies from Australia, the UK, New Zealand, Singapore, Canada, the USA and the Netherlands (Cuffe et al, 2012;Grose et al, 2011;Haasbeek et al, 2012;Landrum et al, 2012;Ngeow et al, 2010;Stevens et al, 2008;Vinod et al, 2008) although gradual improvements during the 2000s are reported. The under-utilisation of treatment for the elderly is evident in population-based studies from Australia, the UK, New Zealand, Singapore, Canada, the USA and the Netherlands (Cuffe et al, 2012;Grose et al, 2011;Haasbeek et al, 2012;Landrum et al, 2012;Ngeow et al, 2010;Stevens et al, 2008;Vinod et al, 2008) although gradual improvements during the 2000s are reported.…”

Section: Gap 4: Older Age and Co-morbidities Influence The Use Of Tmentioning

confidence: 99%

“…A variety of definitions for elderly exist in the literature as over 60, over 70 and 75 plus (Ng, de Boer & Green, 2005). The under-utilisation of treatment for the elderly is evident in population-based studies from Australia, the UK, New Zealand, Singapore, Canada, the USA and the Netherlands (Cuffe et al, 2012;Grose et al, 2011;Haasbeek et al, 2012;Landrum et al, 2012;Ngeow et al, 2010;Stevens et al, 2008;Vinod et al, 2008) although gradual improvements during the 2000s are reported. A Canadian study of NSCLC patients showed uptake of adjuvant chemotherapy in the elderly was consistently below that for patients less than 70 years; notwithstanding, between 2001-2003 and 2004-2006 there was an increase in chemotherapy uptake in the elderly from 3.3% to 16.2% (2004-2006) with concomitant increase in survival (Cuffe et al, 2012).…”

Section: Gap 4: Older Age and Co-morbidities Influence The Use Of Tmentioning

confidence: 99%

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Evidence-practice gaps in lung cancer: A scoping review

et al. 2016

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Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

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“…These differences have increased in recent years, although survival has improved in both countries (Elwood, Aye, & TinTin, ). Much of this disparity is because NZ patients are generally diagnosed at a more advanced stage, as has been shown in studies of, for example, lung (Beatty, Stevens, Stevens, Kolbe, & Cox, ; Stevens, Stevens, Kolbe, & Cox, ), breast (Seneviratne et al., ) and colorectal cancer (Jackson et al., ). Such differences have been seen in other international comparisons and have been influential with regard to re‐organisation of cancer care services, for example, in England and Wales (Richards, , ) and in Denmark (Vedsted & Olesen, ).…”

Section: Introductionmentioning

confidence: 99%

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

et al. 2017

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A national internet-based survey of New Zealand (NZ) primary care physicians (n = 192) used the survey instrument developed by the International Cancer Benchmarking Partnership (ICBP). Practitioners were recruited by a range of methods assisted by NZ general practice networks and contacts. Compared to 11 other ICBP jurisdictions, direct access to diagnostic tests was more limited and took more time than in most other areas; the average wait for a test to be done and reported was 3.0 weeks for X-rays and 8.0 for ultrasound, compared to ICBP averages of 1.6 and 4.7 weeks respectively. Forty-five per cent of respondents could get specialist advice within 48 hr. Sixty-six per cent were aware of NZ guidelines for cancer in primary care, and of those 44% consulted them sometimes or often. Access to tests was greater, and time required much less, in the private than the public care system. NZ respondents each answered two of five clinical vignettes, with results similar to other ICBP areas. The survey also included general practice trainees (N = 42); their results were similar to the main group. The results suggest that improvements in prompt access to diagnostic tests and referrals for suspected cancer need to be given priority in NZ.

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Management of stages I and II non‐small‐cell lung cancer in a New Zealand study: divergence from international practice and recommendations

Cited by 25 publications

References 36 publications

Does comorbidity explain the ethnic inequalities in cervical cancer survival in New Zealand? A retrospective cohort study

Does comorbidity explain the ethnic inequalities in cervical cancer survival in New Zealand? A retrospective cohort study

Evidence-practice gaps in lung cancer: A scoping review

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

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