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

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

doi:10.1016/j.canep.2018.09.001

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

Cancer Epidemiol. 2018 Dec:57:13-23. doi: 10.1016/j.canep.2018.09.001. Epub 2018 Sep 27.

Authors

Daniela Tataru¹, Katie Spencer², Andrew Bates³, Andrzej Wieczorek⁴, Ruth H Jack⁵, Michael D Peake⁶, Michael J Lind⁷, Margreet Lüchtenborg⁸

Affiliations

¹ National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, UK. Electronic address: daniela.tataru@phe.gov.uk.
² Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology, University of Leeds, UK.
³ University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁴ Hull and East Yorkshire NHS Trust, Hull, UK.
⁵ National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, UK.
⁶ National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, UK; Institute for Lung Health, University of Leicester, Leicester, UK; Centre for Cancer Outcomes, University College London Hospitals, London, UK.
⁷ Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, University of Hull, UK.
⁸ National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, UK; Department of Cancer Epidemiology, Population and Global Health, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, UK. Electronic address: margreet.luchtenborg@phe.gov.uk.

PMID: 30268078
DOI: 10.1016/j.canep.2018.09.001

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 (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.

Keywords: Curative treatment; England; Geographical variation; Non-small cell lung cancer; Radical radiotherapy; Surgical resection.

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung / mortality*
Carcinoma, Non-Small-Cell Lung / therapy*
England
Female
Geography
Health Services Accessibility*
Humans
Logistic Models
Lung Neoplasms / mortality*
Lung Neoplasms / therapy*
Male
Middle Aged