How do patient and hospital features influence outcomes in small-cell lung cancer in England?

Abstract

Background:Our aim was to systematically determine how features of patients and hospitals influence access to chemotherapy and survival for people with small-cell lung cancer in England.Methods:We linked the National Lung Cancer Audit and Hospital Episode Statistics and used multiple logistic and Cox regression analyses to assess the influence of patient and hospital features on small-cell lung cancer outcomes.Results:There were 7845 patients with histologically proven small-cell lung cancer. Sixty-one percent (4820) of the patients received chemotherapy. Increasing age, worsening performance status, extensive stage and greater comorbidity all reduced the likelihood of receiving chemotherapy. There was wide variation in access to chemotherapy between hospitals in general and patients first seen in centres with a strong interest in clinical trials had a higher odds of receiving chemotherapy (adjusted odds ratio 1.42, 95% confidence interval (CI) 1.06, 1.90). Chemotherapy was associated with a lower mortality rate (adjusted hazard ratio 0.51, 95% CI 0.46, 0.56).Conclusion:Patients first seen at a hospital with a keen interest in clinical trials are more likely to receive chemotherapy, and chemotherapy was associated with improved survival.

Engagement in research: an innovative three-stage review of the benefits for health-care performance

“…prior research involvement in general, nor membership of the network, but not in the specific trial, made an impact. Some differences between the hurdles needed to cross to implement the respective drug and behavioural treatments might explain the differences 'comparatively farther along the "S-shaped curve" that characterises the diffusion of innovations (Rogers, 1995 Of the 21 papers in the by-product category described above, 17 97,99,[101][102][103][104][105]107,108,[110][111][112][113][114][115][116][117] produced positive findings about the link between research engagement and improved performance. We classified seven of the positive studies as important to our review.…”

“…102,110,111,113,[114][115][116] Four papers 98,100,106,109 produced negative, or mixed/negative, findings and we classified two of these as important. 98,109 Most of the 17 papers 97,99,[101][102][103][104][105]107,108,[110][111][112][113][114][115][116][117] reporting positive findings described measurable improvements in the processes of care thought to lead to better outcomes, rather than better health outcomes per se. Just six studies reported better health outcomes, three of which had been included in Clarke and Loudon's review (du Bois et al, 102 Jha et al 105 and Majumdar et al…”

“…The 21 papers in this group included 12 from Clarke and Loudon, [97][98][99][100][101][102]104,105,[108][109][110][111] and a further nine papers consisting of four published since the Clarke and Loudon search, [114][115][116][117] and others that were the result of our wider inclusion criteria. Some of the additional papers fell into both categories.…”

“…They included 12 of the 13 papers in Clarke and Loudon's review, [97][98][99][100][101][102]104,105,[108][109][110][111] and an additional 21 papers, 103,106,107,[112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129] including 10 published since the beginning of 2009 [114][115][116][117][118][119]121,123,126,128 when Clarke and Loudon conducted their search. We had a broader remit and conducted our search in a different way, but we were able to benefit from knowing which papers they had included and ensuring that our search terms captured as many of these papers as possible.…”

“…We classified the impact in 10 99,102,103,108,110,[113][114][115][116][117] of the 17 positive by-product studies as being either entirely, or mainly, in our broader category. We also classified six of these studies as being important studies.…”