Background: The impact of cardiovascular disease (CVD) comorbidity on resection rates and survival for patients with early-stage non-small-cell lung cancer (NSCLC) is unclear. We explored if CVD comorbidity explained surgical resection rate variation and the impact on survival if resection rates increased. Methods: Cancer registry data consisted of English patients diagnosed with NSCLC from 2012 to 2016. Linked hospital records identified CVD comorbidities. We investigated resection rate variation by geographical region using funnel plots; resection and death rates using time-to-event analysis. We modelled an increased propensity for resection in regions with the lowest resection rates and estimated survival change. Results: Among 57,373 patients with Stage 1−3A NSCLC, resection rates varied considerably between regions. Patients with CVD comorbidity had lower resection rates and higher mortality rates. CVD comorbidity explained only 1.9% of the variation in resection rates. For every 100 CVD comorbid patients, increasing resection in regions with the lowest rates from 24 to 44% would result in 16 more patients resected and alive after 1 year and two fewer deaths overall. Conclusions: Variation in regional resection rate is not explained by CVD comorbidities. Increasing resection in patients with CVD comorbidity to the levels of the highest resecting region would increase 1-year survival.
Bibliographical noteFunding Information:
Competing interests C.A.W., M.J.S., P.C.L., M.J.R. and R.H.J. declare no conflicts of interests. D.W. reports other funding from Society for Cardiothoracic Surgery, from Royal College of Surgeons of Edinburgh, personal fees from Medtronic Inc, outside the submitted work. D.A. reports grants and non-financial support from AstraZeneca, grants from Abbott Vascular, outside the submitted work. M.P. reports grants from Boehringer Ingelheim, grants from AstraZeneca, personal fees from BMS Pharmaceuticals, personal fees from Roche Pharmaceutical, personal fees from AstraZeneca, personal fees from Pfizer, personal fees from MSD, outside the submitted work.
This manuscript was generated by the VICORI collaborative which, in addition to the authors, includes John Deanfield, Mark de Belder, Adam Timis, Chris Gale, Mike Hawkins, Sarah Darby, Alexander Lyon and Alistair Ring, Marlous Hall, Jem Rashbass, Lucy Elliss-Brookes. VICORI are grateful for the advice of our lay representatives, Bob Ward and Paul Charlton and our funders, the British Heart Foundation and Cancer Research UK. We acknowledge the support of the National Institute for Cardiovascular Outcomes Research, Public Health England and their staff.
© 2020, The Author(s).
Copyright 2020 Elsevier B.V., All rights reserved.