Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service

Abstract

BackgroundThe treatment given to patients with lung cancer and survival vary between and within countries. The National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics was used to quantify the extent to which these outcomes are influenced by patient features and/or hospital facilities and performance indicators. Methods All patients with a histological diagnosis of non-small cell lung cancer (NSCLC) were included. Logistic regression was used to quantify the independent influence of features of both patients and hospitals on the likelihood of having surgery and Cox regression was used for survival analyses. Results There were 34 513 patients with NSCLC in our dataset. After adjusting for age, sex, performance status, stage and Charlson Index of comorbidity, patients with NSCLC first seen in thoracic surgical centres (27% of the cohort) were 51% more likely to have surgery than those seen in non-surgical centres (adjusted OR 1.51, 95% CI 1.16 to 1.97). Resection rates varied from 13% to 17% between non-surgical and thoracic surgical centres. Surgery was the most powerful determinant of overall survival (adjusted HR 0.41, 95% CI 0.39 to 0.44). Conclusion A minority of patients with NSCLC first seen in a thoracic surgical centre are more likely to have surgery and to benefit from the survival advantage this confers. This finding suggests that there is an opportunity to improve the outcome for patients with lung cancer in England by optimising access to thoracic surgeons in non-surgical centres.

The European initiative for quality management in lung cancer care

“…For England and Wales, the National Lung Cancer Audit has shown significant regional inequalities in resection rates and other active treatment rates [55][56][57]. Several Norwegian studies have shown regional variations in resection rates and risk factors for post-operative mortality, as well as in the radiotherapy and chemotherapy regimens used [58][59][60][61].…”

Recent advances in the management of lung cancer

“…The 2016 National Lung Cancer Audit reported that the range of patients with non-small cell lung cancer (NSCLC) who received surgical treatment varied from 5% to 36% across different trusts. 3 Previous studies have also demonstrated that a person can be up to 51% more likely to receive thoracic surgery for lung cancer if they are first diagnosed in a thoracic surgical centre, 14,15 and this effect is most pronounced in surgical centres with the largest lung cancer populations.…”

Low Lung Cancer Resection Rates in a Tertiary Level Thoracic Center in Nepal - Where Lies Our Problem?

“…In a UK regional study (Billing et al, 1996) showed that the mean total delay from presentation to operation for Non Small Cell Lung Cancer (NSCLC) was 109 days. Rich (Rich et al, 2011) also from UK found that resection rates and subsequently survival data were better when patients had easier access to thoracic surgical facilities. In India where conditions are not very different from ours, Chandra (Chandra et al, 2009) found the median symptom to initiation delay to be 185 days.…”