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.
Bibliographical noteFunding Information:
Data for this study was based on patient-level information collected by the National Health Service, as part of the care and support of cancer patients. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England. The travel times were estimated by Dr Peninah Murage, University of East Anglia, as part of her PhD research on geographical variation in access to cancer services and outcomes. Appendix A
- Curative treatment
- Geographical variation
- Non-small cell lung cancer
- Radical radiotherapy
- Surgical resection