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

Abstract

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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