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Variation in geographical treatment intensity affects survival of non-small cell lung cancer patients in England

Tataru, Daniela; Spencer, Katie; Bates, Andrew; Wieczorek, Andrzej; Jack, Ruth H.; Peake, Michael D.; Lind, Michael J.; Lüchtenborg, Margreet

Authors

Daniela Tataru

Katie Spencer

Andrew Bates

Andrzej Wieczorek

Ruth H. Jack

Michael D. Peake

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Professor Michael Lind M.J.Lind@hull.ac.uk
Foundation Professor of Oncology/ Head of the Joint Centre for Cancer Studies

Margreet Lüchtenborg



Abstract

© 2018 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 (OR 1.16, 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.

Citation

Tataru, D., Spencer, K., Bates, A., Wieczorek, A., Jack, R. H., Peake, M. D., …Lüchtenborg, M. (2018). Variation in geographical treatment intensity affects survival of non-small cell lung cancer patients in England. Cancer epidemiology, 57, 13-23. https://doi.org/10.1016/j.canep.2018.09.001

Journal Article Type Article
Acceptance Date Sep 8, 2018
Online Publication Date Sep 27, 2018
Publication Date 2018-12
Deposit Date May 30, 2022
Journal Cancer Epidemiology
Print ISSN 1877-7821
Electronic ISSN 1877-783X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 57
Pages 13-23
DOI https://doi.org/10.1016/j.canep.2018.09.001
Keywords Non-small cell lung cancer; Curative treatment; Surgical resection; Radical radiotherapy; Geographical variation; England
Public URL https://hull-repository.worktribe.com/output/3597034
Related Public URLs https://eprints.whiterose.ac.uk/135673/