Tataru, D, Spencer, K orcid.org/0000-0002-6846-4341, Bates, A et al. (5 more authors) (2018) Variation in geographical treatment intensity affects survival of non-small cell lung cancer patients in England. Cancer Epidemiology, 57. pp. 13-23. ISSN 1877-7821
Abstract
Objectives. We aimed to determine the geographical variation in the proportion of non-small cell lung cancer (NSCLC) patients undergoing curative treatment and assess the relationship between treatment access rates and survival outcomes.
Methods. We extracted cancer registration data on 144,357 lung cancer (excluding small cell tumours) patients diagnosed between 2009 and 2013. Surgical and radiotherapy treatment intensity quintiles were based on patients’ Clinical Commissioning Group (CCG) of residence. We used logistic regression to assess the effect of travel time and case-mix on treatment use and Cox regression to analyse survival in relation to treatment intensity.
Results. There was wide variation in the use of curative treatment across CCGs, with the proportion undergoing surgery ranging from 8.9% to 20.2%, and 0.4% to 16.4% for radical radiotherapy. The odds of undergoing surgery decreased with socioeconomic deprivation (OR 0.91, 95% CI 0.85-0.97), whereas the opposite was observed for radiotherapy (OR1.16, 95% CI 1.08-1.25). There was an overall effect of travel time to thoracic surgery centre on the odds of undergoing surgery (OR 0.81, 95% CI 0.76-0.87 for travel time >55 min vs ≤15 min) which was amplified by the effect of deprivation. No clear association was observed for radiotherapy. Higher mortality rates were observed for the lower resection and radiotherapy quintiles (HR 1.08, 95% CI 1.04-1.12 and HR 1.06, 95% CI 1.02-1.10 for lowest vs. highest resection and radiotherapy quintile).
Conclusion. There was wide geographical variation in the use of curative treatment and a higher frequency of treatment was associated with better survival.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Crown Copyright © 2018 Published by Elsevier Ltd. This is an author produced version of a paper published in Cancer Epidemiology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Non-small cell lung cancer; Curative treatment; Surgical resection; Radical radiotherapy; Geographical variation; England |
Dates: |
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Institution: | The University of Leeds |
Depositing User: | Symplectic Publications |
Date Deposited: | 24 Sep 2018 17:07 |
Last Modified: | 27 Sep 2019 00:38 |
Status: | Published |
Publisher: | Elsevier BV |
Identification Number: | 10.1016/j.canep.2018.09.001 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:135673 |
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