Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service
BackgroundThe 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...
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| Veröffentlicht in: | Thorax 2011-12, Vol.66 (12), p.1078-1084 |
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| creator | Rich, Anna L Tata, Laila J Free, Catherine M Stanley, Rosamund A Peake, Michael D Baldwin, David R Hubbard, Richard B |
| description | BackgroundThe 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.MethodsAll 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.ResultsThere 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).ConclusionA 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. |
| doi_str_mv | 10.1136/thx.2011.158972 |
| format | Article |
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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.MethodsAll 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.ResultsThere 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).ConclusionA 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.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thx.2011.158972</identifier><identifier>PMID: 21785158</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - surgery ; Cardiology. Vascular system ; Comorbidity ; England - epidemiology ; Female ; Health Services Accessibility ; Hospitals ; Humans ; Logistic Models ; Lung cancer ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - surgery ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Pneumonectomy - statistics & numerical data ; Proportional Hazards Models ; Quality of Health Care ; Survival Analysis ; Treatment Outcome ; Tumors of the respiratory system and mediastinum</subject><ispartof>Thorax, 2011-12, Vol.66 (12), p.1078-1084</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 (c) 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b430t-de64eb20e7dd3360933dcf17265c7d506029b2d8676f3a3fd69ae0b7caa8f5603</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://thorax.bmj.com/content/66/12/1078.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://thorax.bmj.com/content/66/12/1078.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25250203$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21785158$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rich, Anna L</creatorcontrib><creatorcontrib>Tata, Laila J</creatorcontrib><creatorcontrib>Free, Catherine M</creatorcontrib><creatorcontrib>Stanley, Rosamund A</creatorcontrib><creatorcontrib>Peake, Michael D</creatorcontrib><creatorcontrib>Baldwin, David R</creatorcontrib><creatorcontrib>Hubbard, Richard B</creatorcontrib><title>Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service</title><title>Thorax</title><addtitle>Thorax</addtitle><description>BackgroundThe 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.MethodsAll 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.ResultsThere 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).ConclusionA 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Cardiology. Vascular system</subject><subject>Comorbidity</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Health Services Accessibility</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Pneumonectomy - statistics & numerical data</subject><subject>Proportional Hazards Models</subject><subject>Quality of Health Care</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Tumors of the respiratory system and mediastinum</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqF0U2L1TAUBuAginMdXbuTgIgg9M5Jcpu27mQYdWDAja5Lmp54c2mTmaQR_Rf-5DnlXj9w46Yf8Jw37XkZey5gK4TSF8v--1aCEFtRt10jH7CN2Om2UrLTD9kGYAeVVo0-Y09yPgBAK0TzmJ1J0bQ1jWzYz-uAd8VMfvGYuQ88lsXGmZ5dTDzEUOXZTBO3SJephK_cmmAxveXLHsm7qSC98-i4nXzw1pDdm2TsgsnnxdvMTRi5Q7OURLEE18kprvKvQJ4xffMWn7JHzkwZn53u5-zL-6vPlx-rm08fri_f3VTDTsFSjah3OEjAZhyV0tApNVonGqlr24w1aJDdIMdWN9opo9yoO4MwNNaY1tUa1Dl7fcy9TfGuYF762ef1L03AWHLfQa0pTUuSL_-Rh1hSoI_raY2iFaqVNamLo7Ip5pzQ9bfJzyb96AX0a1c9ddWvXfXHrmjixSm3DDOOv_2vcgi8OgGTaVsu0aJ8_uNqWYMERe7N0Q3z4b-n3gN1hKtx</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Rich, Anna L</creator><creator>Tata, Laila J</creator><creator>Free, Catherine M</creator><creator>Stanley, Rosamund A</creator><creator>Peake, Michael D</creator><creator>Baldwin, David R</creator><creator>Hubbard, Richard B</creator><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20111201</creationdate><title>Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service</title><author>Rich, Anna L ; Tata, Laila J ; Free, Catherine M ; Stanley, Rosamund A ; Peake, Michael D ; Baldwin, David R ; Hubbard, Richard B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b430t-de64eb20e7dd3360933dcf17265c7d506029b2d8676f3a3fd69ae0b7caa8f5603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Cardiology. Vascular system</topic><topic>Comorbidity</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Health Services Accessibility</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Pneumonectomy - statistics & numerical data</topic><topic>Proportional Hazards Models</topic><topic>Quality of Health Care</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Tumors of the respiratory system and mediastinum</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rich, Anna L</creatorcontrib><creatorcontrib>Tata, Laila J</creatorcontrib><creatorcontrib>Free, Catherine M</creatorcontrib><creatorcontrib>Stanley, Rosamund A</creatorcontrib><creatorcontrib>Peake, Michael D</creatorcontrib><creatorcontrib>Baldwin, David R</creatorcontrib><creatorcontrib>Hubbard, Richard B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rich, Anna L</au><au>Tata, Laila J</au><au>Free, Catherine M</au><au>Stanley, Rosamund A</au><au>Peake, Michael D</au><au>Baldwin, David R</au><au>Hubbard, Richard B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>66</volume><issue>12</issue><spage>1078</spage><epage>1084</epage><pages>1078-1084</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>BackgroundThe 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.MethodsAll 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.ResultsThere 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).ConclusionA 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.</abstract><cop>London</cop><pub>BMJ Publishing Group</pub><pmid>21785158</pmid><doi>10.1136/thx.2011.158972</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - surgery Cardiology. Vascular system Comorbidity England - epidemiology Female Health Services Accessibility Hospitals Humans Logistic Models Lung cancer Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - surgery Male Medical sciences Middle Aged Pneumology Pneumonectomy - statistics & numerical data Proportional Hazards Models Quality of Health Care Survival Analysis Treatment Outcome Tumors of the respiratory system and mediastinum |
| title | Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service |
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