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Lung cancer
Original article
Geographical variations in the use of cancer treatments are associated with survival of lung cancer patients
  1. Henrik Møller1,2,
  2. Victoria H Coupland3,
  3. Daniela Tataru3,
  4. Michael D Peake3,4,
  5. Anders Mellemgaard5,
  6. Thomas Round1,
  7. David R Baldwin6,
  8. Matthew E J Callister7,
  9. Erik Jakobsen8,
  10. Peter Vedsted2,
  11. Richard Sullivan1,
  12. James Spicer1
  1. 1School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
  2. 2Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus University, Aarhus, Denmark
  3. 3National Cancer Registration and Analysis Service, Public Health England, London, UK
  4. 4Department of Respiratory Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
  5. 5Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
  6. 6Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
  7. 7Department of Respiratory Medicine, St James’s University Hospital, Leeds, UK
  8. 8Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
  1. Correspondence to Professor Henrik Møller, School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; henrik.moller{at}kcl.ac.uk

Abstract

Introduction Lung cancer outcomes in England are inferior to comparable countries. Patient or disease characteristics, healthcare-seeking behaviour, diagnostic pathways, and oncology service provision may contribute. We aimed to quantify associations between geographic variations in treatment and survival of patients in England.

Methods We retrieved detailed cancer registration data to analyse the variation in survival of 176,225 lung cancer patients, diagnosed 2010-2014. We used Kaplan-Meier analysis and Cox proportional hazards regression to investigate survival in the two-year period following diagnosis.

Results Survival improved over the period studied. The use of active treatment varied between geographical areas, with inter-quintile ranges of 9%–17% for surgical resection, 4%–13% for radical radiotherapy, and 22%–35% for chemotherapy. At 2 years, there were 188 potentially avoidable deaths annually for surgical resection, and 373 for radical radiotherapy, if all treated proportions were the same as in the highest quintiles. At the 6 month time-point, 318 deaths per year could be postponed if chemotherapy use for all patients was as in the highest quintile. The results were robust to statistical adjustments for age, sex, socio-economic status, performance status and co-morbidity.

Conclusion The extent of use of different treatment modalities varies between geographical areas in England. These variations are not attributable to measurable patient and tumour characteristics, and more likely reflect differences in clinical management between local multi-disciplinary teams. The data suggest improvement over time, but there is potential for further survival gains if the use of active treatments in all areas could be increased towards the highest current regional rates.

  • lung cancer
  • lung cancer chemotherapy
  • surgery
  • radiotherapy
  • survival

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/thoraxjnl-2017-210710

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    Footnotes

    • Contributors HM, VHC and DT designed the study. VHC, DT and HM assembled the data set. HM analysed the data. All authors contributed to the interpretation of the results. HM and JS organised the drafting of the manuscript. All authors contributed to the writing of the manuscript and approved the final version.

    • Funding The study was supported by the National Cancer Registration and Analysis Service, Public Health England, and by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust.

    • Disclaimer The views expressed are those of the authors and not necessarily those of Public Health England, NIHR, NHS, or the Department of Health.

    • Competing interests TR has a personal grant from the National Institute for Health Research during the period of this work. DRB has received personal fees from Astra Zeneca, outside the submitted work. Other authors have no competing interest to declare.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval The study was covered by Section 251 of the National Health Service Act 2006 which enables the collection and analysis of cancer registration data in England. Therefore, separate ethical approval was not required for this study.

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

    • Data sharing statement This work uses data provided by patients and collected by the NHS as part of their care and support.