Lung cancer: district active treatment rates affect survival

Study objective: This study investigates variation in management and treatment of lung cancer patients and determines the impact of any variation in treatment on survival. Design: A retrospective study of population based data held by the Northern & Yorkshire Cancer Registry and Information Service (NYCRIS), comparing active treatment rates for lung cancer with survival by districts. Setting: The then 17 districts in Yorkshire and South Humber, England. Patients: 22 654 patients registered with lung cancer between 1986 and 1994 and followed up until end of 1996. Results: The overall rates of active treatment (surgery, radiotherapy, and chemotherapy) varied between districts from 37% to 56%. One year survival (with 95% CI) was significantly better in the districts with highest rates of active treatment 23% (22% to 24%) compared with 19% (17% to 20%) for those with lowest treatment rates. Non-small cell lung cancer patients (55%) in the districts with highest active treatment rates had an age adjusted relative risk of death during the follow up period, relative to risk of death in the districts with the lower treatment rates of 0.88 (0.83 to 0.92). Clinically diagnosed patients (34%) had an age adjusted RR of 0.92 (0.86 to 0.96). RR in small cell cancer (11%) was not significant. Conclusion: This study has shown wide variations in the rates of active treatment for lung cancer patients within districts across one large region of England. Active treatment was strongly associated with improved survival, especially in non-small cell lung cancer.

[1]  P Boffetta,et al.  Socioeconomic differences in cancer incidence and mortality. , 1997, IARC scientific publications.

[2]  N. Aaronson,et al.  Quality of life after palliative radiotherapy in non-small cell lung cancer: a prospective study. , 2000, International journal of radiation oncology, biology, physics.

[3]  H. Hansen,et al.  Lung cancer. , 1990, Cancer chemotherapy and biological response modifiers.

[4]  M. Muers,et al.  Management of lung cancer. , 1996, Thorax.

[5]  R A Patchell,et al.  Brain metastases. , 1991, Neurologic clinics.

[6]  A. Gregor,et al.  Management and survival of patients with lung cancer in Scotland diagnosed in 1995: results of a national population based study , 2001, Thorax.

[7]  M. Muers,et al.  Lung cancer referral patterns in the former Yorkshire region of the UK , 2002, British Journal of Cancer.

[8]  G. Beauchamp,et al.  World Health Statistics Quarterly , 1985 .

[9]  M. Muers,et al.  Investigation, treatment and prognosis of bronchial carcinoma in the Yorkshire Region of England 1976-1983. , 1990, British Journal of Cancer.

[10]  D. Forman,et al.  Variation in survival of patients with lung cancer in Europe, 1985-1989. EUROCARE Working Group. , 1998, European journal of cancer.

[11]  W. Fry,et al.  Ten‐year survey of lung cancer treatment and survival in hospitals in the United States , 1999, Cancer.

[12]  M. Whitehouse,et al.  A policy framework for commissioning cancer services , 1995, BMJ.

[13]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .

[14]  T. British,et al.  BTS guidelines: guidelines on the selection of patients with lung cancer for surgery. , 2001, Thorax.

[15]  Time trends in the outcome of lung cancer management: a study of 9,090 cases diagnosed in the Mersey Region, 1974-86. , 1990, British Journal of Cancer.

[16]  H. Welch,et al.  Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews , 1998, BMJ.

[17]  R. Yung,et al.  Radicalism in therapy of lung cancer , 2001, The Lancet.

[18]  M. Muers,et al.  Carcinoma of the bronchus in the Yorkshire region of England 1976-1990: trends since 1984. , 1997, The European respiratory journal.

[19]  A. Gregor,et al.  Management of lung cancer in South East Scotland. , 1996, Thorax.

[20]  M. Socinski,et al.  Beliefs among pulmonologists and thoracic surgeons in the therapeutic approach to non-small cell lung cancer. , 2000, Chest.

[21]  D. Brewster,et al.  Breast, lung and colorectal cancer incidence and survival in South Thames Region, 1987-1992: the effect of social deprivation. , 1998, Journal of public health medicine.

[22]  K. Roszkowski,et al.  A multicenter, randomized, phase III study of docetaxel plus best supportive care versus best supportive care in chemotherapy-naive patients with metastatic or non-resectable localized non-small cell lung cancer (NSCLC). , 2000, Lung cancer.

[23]  J. Coebergh,et al.  Socioeconomic variation in cancer survival in the Southeastern Netherlands, 1980‐1989 , 1995, Cancer.

[24]  J. Coebergh,et al.  Socioeconomic status and breast cancer survival in the southeastern Netherlands, 1980-1989. , 1995, European journal of cancer.