No abstract

No abstract

Background:UK residents' healthcare is free of charge but uptake varies. Cancer survival is inferior to that of other Western European countries. We have used cancer registry data to assess factors associated with access to diagnosis and treatment of lung cancer in northern England.Method:We assigned 34 923 lung cancer patients diagnosed between 1994 and 2002 to quartiles for the deprivation score associated with their postcode and for the travel time to the relevant healthcare facility. Odds ratios, adjusted for age and sex, for undergoing interventions were calculated relative to the least deprived quartile living closest to the facility. The odds ratio for receiving chemotherapy for small-cell lung cancer (SCLC) was calculated according to the type of hospital where it was diagnosed.Results:The odds ratio for attainment of a histological diagnosis for the least deprived/furthest residence group was 0.83 (95% confidence 0.70–0.97) for the most deprived/nearest residence group was 0.74(0.62–0.87) and for the most deprived/furthest residence group it was 0.61 (0.49–0.75). The corresponding odds ratios for receipt of any active treatment were 0.93 (0.80–1.07), 0.74 (0.64–0.86), and 0.55 (0.46–0.67). The odds ratios for receipt of chemotherapy for SCLC were 1.27 (0.89–1.82), 1.21 (0.85–1.74) and 0.81 (0.52–1.28). Odds ratios for undergoing surgery for non-small cell lung cancer using (1) travel time to diagnosing hospital were 0.88 (0.70–1.11), 0.74 (0.59–0.94) and 0.60 (0.44–0.84). Using (2) travel time to a thoracic surgery facility they were 0.83 (0.65–1.06), 0.70 (0.55–0.89) and 0.55 (0.49–0.76).Conclusion:Living in a deprived locality reduces the likelihood of undergoing definitive management for lung cancer with the exception of chemotherapy for SCLC. This is amplified by travel time to services.

No abstract

ObjectiveCancer outcomes vary between and within countries with patients from deprived backgrounds known to have inferior survival. The authors set out to explore the effect of deprivation in relation to the accessibility of hospitals offering diagnostic and therapeutic services on stage at presentation and receipt of treatment.DesignAnalysis of a Cancer Registry Database. Data included stage and treatment details from the first 6 months. The socioeconomic status of the immediate area of residence and the travel time from home to hospital was derived from the postcode.SettingPopulation-based study of patients resident in a large area in the north of England.Participants39 619 patients with colorectal cancer diagnosed between 1994 and 2002.Outcomes measuredStage of diagnosis and receipt of treatment in relation to deprivation and distance from hospital.ResultsPatients in the most deprived quartile were significantly more likely to be diagnosed at stage 4 for rectal cancer (OR 1.516, p<0.05) but less so for colonic cancer. There was a trend for both sites for patients in the most deprived quartile to be less likely to receive chemotherapy for stage 4 disease. Patients with colonic cancer were very significantly less likely to receive any treatment if they came from any but the most affluent area (ORs 0.639, 0.603 and 0.544 in increasingly deprived quartiles), this may have been exacerbated if the hospital was distant from their residence (OR for forth quartile for both travel and deprivation 0.731, not significant). The effect was less for rectal cancer and no effect of distance was seen.ConclusionsResiding in a deprived area is associated with tendencies to higher stage at diagnosis and especially in the case of colonic cancer to reduced receipt of treatment. These observations are consistent with other findings and indicate that access to diagnosis requires further investigation.