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Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service
  1. Anna L Rich1,
  2. Laila J Tata1,
  3. Catherine M Free2,
  4. Rosamund A Stanley3,
  5. Michael D Peake2,
  6. David R Baldwin4,
  7. Richard B Hubbard1,5
  1. 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
  2. 2Department of Respiratory Medicine, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK
  3. 3Audit Support Unit, The NHS Information Centre for Health and Social Care, Leeds, UK
  4. 4Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
  5. 5Respiratory Medicine Biomedical Research Unit, Nottingham City Hospital, Nottingham, UK
  1. Correspondence toDr Anna L Rich, Clinical Sciences Building, City Campus, Hucknall Road, Nottingham NH5 1PB, UK;{at}


Background The 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.

  • Lung cancer
  • non-small cell lung cancer
  • thoracic surgery
  • clinical epidemiology

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  • See Editorial, p 1023

  • Funding ALR is funded by a Royal College of Physicians Clinical Quality Improvement Research and Training Fellowship. RBH is the current GSK/British Lung Foundation Professor of Respiratory Epidemiology.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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