Patterns of initial management of lung cancer in the Republic of Ireland: a population-based observational study
Introduction
Throughout the 1990s, a number of studies have described wide variations in cancer treatment by geographic location and patients’ age, socioeconomic status, and ethnicity [1], [2], [3], [4], [5]. The underlying purpose of such studies was to estimate the extent to which variation in care affects outcome, and thus help formulate more equitable policies by targeting the areas and subgroups in greatest need. Typically, these studies involved patients with more curable cancers like breast and colorectal cancers. Relatively few studies examined regional variation in lung cancer treatment using national population-based data [6], [7], [8].
Since 1994, the National Cancer Registry of Ireland (NCRI) has gathered patient, tumour, and treatment details for all incident cancers in the Republic of Ireland. The aim of the work presented here was to use the NCRI database to examine geographic and temporal trends in the patterns of initial management of lung cancer, and to describe differences in case management according to certain patient and tumour characteristics. We were particularly interested in examining differences in treatment patterns between the catchment areas of the country's eight health boards. Each health board provides health, welfare, and social services to the residents of its catchment area. The Eastern Health Board, which includes Dublin, has the largest population (1.3 million, or 36% of the Irish population), followed by the Southern (15%), South-Eastern (11%), and Western (10%) health boards.
The national coverage of the NCRI provides a population perspective on cancer treatment in Ireland that is not available from any other source. Analysis of treatment trends is an essential part of the development and evaluation of national guidelines for lung cancer management.
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Methods
Patient, tumour, and treatment information were extracted from the database of the NCRI. Data collection is mainly active with information being continuously extracted from medical records by 18 trained nurses each of whom is responsible for one or more hospitals. Analyses have suggested a level of registration completeness of about 96% at 2 years after diagnosis [9]. The 7286 cases included in this analysis were patients with primary malignant lung tumours diagnosed in Ireland between January
Patient and tumour characteristics
A total of 7218 patients were included in this analysis (Table 1). Overall, there were almost twice as many males as females (65.6% vs. 34.4%) (The European age-standardized incidence rate was 62.8 and 26.7 per 100 000 person-years in men and women, respectively.) [9]. The median age at diagnosis was 70 years. Forty-one percent resided in the Eastern Health Board area. The number of incident tumours was relatively constant over the five years studied, approximately 1450 cases annually.
Most
Discussion
We found that between 1994 and 1998, only half of newly diagnosed lung cancer patients in Ireland received any cancer-specific treatment. SCLC cases were more likely to be treated compared to NSCLC or histologically unconfirmed cases. Generally, our treatment rates are similar to those reported for Scotland [6] and Yorkshire, England [11] but lower than those reported from the USA [12] (Table 6). Similarly, the Irish survival rates are worse than in the USA [8], [9]. While these figures are not
Conclusion
We found wide regional variation in treatment rates of lung cancer in Ireland. Further research is required to achieve a better understanding of the mechanisms underlying clinical decision-making with regard to cancer treatment and the subsequent impact on patient outcome. Such research can provide the basis for the formulation of national clinical guidelines and treatment protocols to ensure equitable and high standards of care.
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