Socioeconomic Inequalities in Lung Cancer Treatment: Systematic Review and Meta-Analysis

Forrest, Lynne; Adams, Jean; Wareham, Helen; Rubin, Greg; White, Martin

doi:10.1371/journal.pmed.1001376

Cited by 149 publications

(141 citation statements)

References 66 publications

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“…A recent systematic review showed that countries with nonuniversal healthcare, such as the USA, experience SES differences with respect to radiotherapy while most of the studies in countries with universal healthcare, such as Norway and other European countries did not. 4 The one study that used individual measures of education to categorise SES found a pattern similar to ours, although it did not distinguish between radical and palliative radiotherapy. 22 A possible explanation for the differences in results is the use of individual measures versus area-based measures of SES.…”

Section: Discussionsupporting

confidence: 68%

“…[4][5][6][7][8] However, the influence of SES on radiotherapy remains inconclusive. 4,[9][10][11] Previous studies have been unable to examine the association between lung cancer treatment and factors not mentioned in the guidelines, using individual measures of SES. To date there has been no population-based study examining radiotherapy as a treatment for lung cancer, stratified by treatment intention (i.e., radical and palliative radiotherapy).…”

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confidence: 99%

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Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage

Nilssen

Strand

Fjellbirkeland

et al. 2015

Intl Journal of Cancer

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Selection of lung cancer treatment should be based on tumour characteristics, physiological reserves and preferences of the patient. Our aims were to identify and quantify other factors associated with treatment received. Lung cancer patient data from 2002 to 2011 were obtained from the national population-based Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register. Multivariable logistic regression examined whether year of diagnosis, age, sex, education, income, health trust, smoking status, extent of disease, histology and comorbidities were associated with choice of treatment; surgery or radical or palliative radiotherapy, within 1 year of diagnosis. Among the 24,324 lung cancer patients identified, the resection rate remained constant while the proportion of radical radiotherapy administered increased from 8.6 to 14.1%. Older patients, those with lower household incomes and certain health trusts were less likely to receive any treatment. Lower education and the male gender were identified as negative predictors for receiving surgery. Smoking history was positively associated with both radical and palliative radiotherapy, while comorbidity and symptoms were independently associated with receiving surgery and palliative radiotherapy. Although Norway is a highly egalitarian country with a free, universal healthcare system, this study indicates that surgery and radical and palliative radiotherapy were under-used among the elderly, those with a lower socioeconomic status and those living in certain health trusts.According to Norwegian guidelines, lung cancer treatment should be based on extent of disease (EOD), tumor histology, comorbidities, performance status and preferences of the patient.1 Surgical resection is considered a prerequisite for the cure of lung cancer, but a benefit has only been shown for patients with localized disease, that is, disease that does not extend beyond the intrapulmonary or hilar lymph nodes.Stereotactic radiotherapy has recently become an alternative for selected patients. 2,3 If a patient is deemed ineligible for surgical treatment due to EOD or significant comorbidities, radiotherapy and/or chemotherapy can be offered. For patients with mediastinal lymph node metastasis, this combination is offered with curative intent, while for patients whose tumours have spread beyond the lung and mediastinum, in the majority of patients, palliative radiotherapy and/ or chemotherapy are offered for symptom relief, to slow disease progression and improve medium term survival. Likelihood of both receiving surgical treatment and radiotherapy as treatment for lung cancer has previously been shown to be affected by factors not mentioned in guidelines. A number of studies have found that socioeconomic status (SES) and/or place of residence may influence the likelihood of receiving surgical treatment. [4][5][6][7][8] However, the influence of SES on radiotherapy remains inconclusive. 4,[9][10][11] Previous studies have been unable to examine the association between lung canc...

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Section: Discussionsupporting

confidence: 68%

mentioning

confidence: 99%

Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage

Nilssen

Strand

Fjellbirkeland

et al. 2015

Intl Journal of Cancer

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“…These results contradict those of studies examining socio economic status and access to health care in other countries. 29,30 Specific ally in cancer care, differences in socio economic status have been found for several different types of cancer [31][32][33][34] and may influence cancer-related outcomes. Canada's public health care system mandates equal access for all patients, regardless of socio economic status.…”

Section: Discussionmentioning

confidence: 99%

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Gillis

Dixon

Smith

et al. 2014

cjs

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Background: Administrative wait times reflect the time from the decision to treat until surgery; however, this does not reflect the total time a patient actually waits for treatment. Several factors may prolong the wait for colon cancer surgery. We sought to analyze the time from the date of surgical consultation to the date of surgery and any events within this time frame that may extend wait times. Methods:We retrospectively reviewed the cases of all adult patients in Ontario aged 18-80 years with diagnosed colon cancer who did not receive neoadjuvant therapy and underwent resection electively between Jan. 1, 2002, and Dec. 31, 2009. Wait times were measured from the date of surgical consultation to the date of surgery. We chose a wait time of 28 days, reflecting local administrative targets, as a comparative benchmark. We performed univariate and multivariate analyses to identify variables contributing to a waits longer than 28 days. Variables were analyzed in continuous linear and logistic regression models. Results:We included 10 223 patients in our study. The median wait time from initial surgical consultation to resection was 31 (range 0-182) days. Age older than 65 years had a negative impact on wait time. Preoperative services, including computed tomography, cardiac consultation, echocardiography, multigated acquisition scan, magnetic resonance imaging, colonoscopy and cardiac catheterization also significantly increased wait times. Wait times were longer in rural hospitals. Conclusion:Preoperative services significantly increased wait times between initial surgical consultation and surgery.Contexte : Au plan administratif, les temps d'attente sont le reflet de l'intervalle entre la prise de décision de traiter et la chirurgie elle-même. Toutefois, cette mesure ne tient pas toujours compte du temps total d'attente d'un patient pour son traitement. Plusieurs facteurs peuvent prolonger l'attente dans le cas d'une chirurgie pour le cancer du côlon. Nous avons voulu mesurer le temps écoulé entre la date de la consultation en chirurgie et la date de la chirurgie, et tout événement à l'intérieur de cet intervalle susceptible de prolonger les délais.Méthodes : Nous avons passé en revue de façon rétrospective le cas de tous les patients adultes ontariens âgés de 18 à 80 ans porteurs d'un diagnostic de cancer du côlon qui n'ont pas reçu de traitement néo-adjuvant et qui ont subi une résection non urgente entre le 1er janvier 2002 et le 31 décembre 2009. Les temps d'attente ont été mesurés entre la date de la consultation en chirurgie et la date de la chirurgie elle-même. Nous avons choisi un temps d'attente de 28 jours qui reflète les objectifs administratifs locaux comme valeur comparative. Nous avons effectué des analyses univariées et multivariées pour faire ressortir les facteurs qui contribuent à des périodes d'attente de plus de 28 jours. Les variables ont été analysées selon des modèles de régression linéaire et logistique continue.Résultats : Nous avons inclus 10 223 patients dans notre étude. Le temps d...

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“…The anticipated increase in the number of cases, resulting from aging of modern societies, including the Polish population, but also from growing exposition to some risk factors, stimulates search for strategies that would prevent cancer effects [1,2]. These strategies are targeted mainly at popularization of primary [3] and secondary [4] prevention [3], but also at providing patients with equal accessibility of therapy [5], psychological care and rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Changes in five-year relative survival rates in Poland in patients diagnosed in the years 1999–2010

Wojciechowska¹,

Didkowska²

2018

Nowotwory. Journal of Oncology

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Changes in five-year relative survival rates in Poland in patients diagnosed in the years 1999-2010Urszula Wojciechowska, Joanna Didkowska Introduction. Survival rates are a tool that allows evaluation of healthcare quality and cancer treatment efficiency.The main aim of this article is to present tendencies in curability of Polish patients diagnosed between 1999-2010 and followed up until the end of 2015. Materials and methods. Survival analysis was performed using data from the Polish National Cancer Registry and Statistics Poland. The survival rates were calculated using Hakulinen method.Results. In Poland, five-year survival rates in men for all cancers increased from 32.9% (diagnosis 1999-2001) to 41.3% (diagnosis 2008-2010), whereas in women, from 50.9% to 56.1% respectively.

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Socioeconomic Inequalities in Lung Cancer Treatment: Systematic Review and Meta-Analysis

Cited by 149 publications

References 66 publications

Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage

Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Changes in five-year relative survival rates in Poland in patients diagnosed in the years 1999–2010

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