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Richardson CL, Saeed M, Sharp L, Todd A. The association between marital status and treatment initiation in lung cancer: A systematic review and meta-analysis of observational studies. Cancer Epidemiol 2023; 87:102494. [PMID: 37992417 DOI: 10.1016/j.canep.2023.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Lung cancer is associated with high mortality, and significant health burden. Marital status has been associated with lung cancer survival. This systematic review and meta-analysis set out to investigate the association between marital status and treatment receipt in lung cancer. The search was conducted across three databases: Medline (OVID), Embase and CINAHL, from inception to June 2022. Retrospective or prospective observational studies that quantified treatment receipt by marital status were eligible for inclusion. Study quality was assessed via a modified checklist for retrospective databased-based studies. Meta-analysis using a random effects model was undertaken by chemotherapy, radiotherapy, surgery, and any treatment relative to married or not married. Pooled unadjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each type of treatment. 837 papers were screened and 18 met the inclusion criteria with eight being eligible for inclusion in the meta-analysis. Studies were excluded from meta-analysis due to overlap in the data reported in papers; the mean quality score of the 18 included papers was 12/17. Being married was associated with increased odds of overall treatment OR 1.43 (95 % CI 1.14-1.79; I2 = 82 %; Tau2 = 0.07; six studies) and also increased receipt of: chemotherapy 1.40 (95 % CI 1.35-1.44; I2 = 82 %; Tau2 = 0.00); radiotherapy 1.29 (95 % CI 0.96-1.75; I2 = 100 %; Tau2= 0.09; four studies) and surgery (95 % CI 1.31-1.52; I2 = 86 %; Tau2 = 0.00; five studies). The results indicate that those who are married are more likely to receive treatment for lung cancer compared to those who are not married. This requires further investigation to better understand the explanations behind this finding and how we can work to combat this inequality.
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Affiliation(s)
- Charlotte Lucy Richardson
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK.
| | - Mariam Saeed
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, King George VI Building, King's Road, Newcastle-upon-Tyne NE1 7RU, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
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Stage III Non-small Cell Lung Cancer Management in England. Clin Oncol (R Coll Radiol) 2020; 31:688-696. [PMID: 31514942 DOI: 10.1016/j.clon.2019.07.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Abstract
AIMS We present the first analysis of the management and outcomes of stage III non-small cell lung cancer (NSCLC) conducted in England using National Lung Cancer Audit data. MATERIALS AND METHODS Patients diagnosed with stage III NSCLC in 2016 were identified. Linked datasets (including Hospital Episode Statistics, the National Radiotherapy Dataset, the Systemic Anti-Cancer Dataset, pathology reports and death certificate data) were used to categorise the treatment received. Kaplan-Meier survival curves were obtained, with survival defined from the date of diagnosis to the date of death. RESULTS In total, 6276 cases of stage III NSCLC were analysed: 3827 stage IIIA and 2449 stage IIIB; 1047 (17%) patients were treated with radical radiotherapy with 676 (11%) of these also receiving chemotherapy. Twenty per cent of patients with stage IIIA disease underwent surgery, with half of these also receiving chemotherapy, predominantly delivered in the adjuvant setting. Of note, 2148 (34%) patients received palliative-intent treatment and 2265 (36%) received no active anti-cancer treatment. The 1-year survival was 32.9% (37.4% for stage IIIA), with the highest survival seen for those patients receiving chemotherapy and surgery. CONCLUSIONS We highlight important gaps in the optimal care of patients with stage III NSCLC in England. Multimodality treatment with either surgery or radical radiotherapy combined with chemotherapy was delivered to less than one-fifth of patients, even though these regimens are considered optimal. Timely access to specialist resources and staff, the practice of effective shared decision making and challenging preconceptions have the potential to optimise management.
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Impact on survival of modelling increased surgical resection rates in patients with non-small-cell lung cancer and cardiovascular comorbidities: a VICORI study. Br J Cancer 2020; 123:471-479. [PMID: 32390010 PMCID: PMC7403296 DOI: 10.1038/s41416-020-0869-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Mileshkin L, Dunn C, Cross H, Duffy M, Shaw M, Antippa P, Mitchell P, Akhurst T, Conron M, Moore M, Philip J, Bartlett J, Emery J, Zambello B. The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia. Intern Med J 2018; 49:1001-1006. [PMID: 30515932 DOI: 10.1111/imj.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers. AIM To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service. METHODS We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data. RESULTS Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services. CONCLUSION Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.
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Affiliation(s)
- Linda Mileshkin
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine Dunn
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hannah Cross
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Mary Duffy
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Shaw
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phillip Antippa
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Tim Akhurst
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Melissa Moore
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jenny Philip
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Jon Emery
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Zambello
- Western and Central Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
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Møller H, Coupland VH, Tataru D, Peake MD, Mellemgaard A, Round T, Baldwin DR, Callister MEJ, Jakobsen E, Vedsted P, Sullivan R, Spicer J. Geographical variations in the use of cancer treatments are associated with survival of lung cancer patients. Thorax 2018; 73:530-537. [PMID: 29511056 PMCID: PMC5969334 DOI: 10.1136/thoraxjnl-2017-210710] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/25/2022]
Abstract
Introduction Lung cancer outcomes in England are inferior to comparable countries. Patient or disease characteristics, healthcare-seeking behaviour, diagnostic pathways, and oncology service provision may contribute. We aimed to quantify associations between geographic variations in treatment and survival of patients in England. Methods We retrieved detailed cancer registration data to analyse the variation in survival of 176,225 lung cancer patients, diagnosed 2010-2014. We used Kaplan-Meier analysis and Cox proportional hazards regression to investigate survival in the two-year period following diagnosis. Results Survival improved over the period studied. The use of active treatment varied between geographical areas, with inter-quintile ranges of 9%–17% for surgical resection, 4%–13% for radical radiotherapy, and 22%–35% for chemotherapy. At 2 years, there were 188 potentially avoidable deaths annually for surgical resection, and 373 for radical radiotherapy, if all treated proportions were the same as in the highest quintiles. At the 6 month time-point, 318 deaths per year could be postponed if chemotherapy use for all patients was as in the highest quintile. The results were robust to statistical adjustments for age, sex, socio-economic status, performance status and co-morbidity. Conclusion The extent of use of different treatment modalities varies between geographical areas in England. These variations are not attributable to measurable patient and tumour characteristics, and more likely reflect differences in clinical management between local multi-disciplinary teams. The data suggest improvement over time, but there is potential for further survival gains if the use of active treatments in all areas could be increased towards the highest current regional rates.
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Affiliation(s)
- Henrik Møller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.,Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Victoria H Coupland
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Daniela Tataru
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Michael D Peake
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Department of Respiratory Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Anders Mellemgaard
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Round
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - David R Baldwin
- Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | | | - Erik Jakobsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Peter Vedsted
- Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - James Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Evison M, Crosbie P, Navani N, Callister M, Rintoul RC, Baldwin D, Booton R. How should performance in EBUS mediastinal staging in lung cancer be measured? Br J Cancer 2016; 115:e9. [PMID: 27552438 PMCID: PMC5061900 DOI: 10.1038/bjc.2016.253] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Matthew Evison
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe M23 9LT, UK
- The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe M23 9LT, UK
- The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospitals and Lungs for Living Research Centre, University College London Respiratory, London, UK
| | - Matthew Callister
- Department of Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge CB23 3RE, UK
| | - David Baldwin
- Nottingham University Hospitals and University of Nottingham, Respiratory Medicine Unit, David Evans Centre, Nottingham City Hospital Campus, Nottingham NG5 1PB, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe M23 9LT, UK
- The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
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Evison M, Crosbie P, Martin J, Shah R, Doran H, Borrill Z, Hoyle J, Rana D, Bailey S, Booton R. EBUS-guided mediastinal lung cancer staging: monitoring of quality standards improves performance. Thorax 2016; 71:762-3. [PMID: 27146201 DOI: 10.1136/thoraxjnl-2015-206985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/06/2016] [Indexed: 12/25/2022]
Abstract
This audit examined key performance indices related to endobronchial ultrasound (EBUS)-guided mediastinal lung cancer staging before and after the introduction of defined quality standards, at four independent EBUS centres in one cancer network. Data from 642 procedures were prospectively collected and analysed. The introduction of standards was associated with a significant increase (p<0.001) in sampling of key mediastinal lymph node stations (4R, 4L and 7) and a reduction in the variability of staging sensitivity between centres. These data reinforce the requirement for an appropriate regulatory framework for EBUS-transbronchial needle aspiration provision that includes quality assurance and performance monitoring.
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Affiliation(s)
- Matthew Evison
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - Julie Martin
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Rajesh Shah
- Department of Thoracic Surgery, University Hospital South Manchester, Manchester, UK
| | - Helen Doran
- Department of Pathology, University Hospital South Manchester, Manchester, UK
| | - Zoe Borrill
- Department of Respiratory Medicine, North Manchester General Hospital, Pennine Acute NHS Trusts, Manchester, UK
| | - Jennifer Hoyle
- Department of Respiratory Medicine, North Manchester General Hospital, Pennine Acute NHS Trusts, Manchester, UK
| | - Durgesh Rana
- Department of Cytopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simon Bailey
- Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK The Institute of Inflammation and Repair, The University of Manchester, Manchester, UK
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Møller H, Riaz SP, Holmberg L, Jakobsen E, Lagergren J, Page R, Peake MD, Pearce N, Purushotham A, Sullivan R, Vedsted P, Luchtenborg M. High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England. Eur J Cancer 2016; 64:32-43. [PMID: 27328450 DOI: 10.1016/j.ejca.2016.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small-cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital. Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 d than patients from the lowest quintile. Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access.
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Affiliation(s)
- Henrik Møller
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK; Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
| | - Sharma P Riaz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
| | - Lars Holmberg
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Erik Jakobsen
- The Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Jesper Lagergren
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Department of Molecular Medicine and Surgery (MMK), K1, Upper Gastrointestinal Research, Övre gastrointestinal forskning, NS 67, Institutionen för molekylär medicin och kirurgi, Karolinska Institutet, 171 76 Stockholm, Sweden.
| | - Richard Page
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.
| | - Michael D Peake
- Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK.
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Arnie Purushotham
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Richard Sullivan
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - Peter Vedsted
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
| | - Margreet Luchtenborg
- King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK.
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Imperatori A, Harrison RN, Dominioni L, Leitch N, Nardecchia E, Jeebun V, Brown J, Altieri E, Castiglioni M, Cattoni M, Rotolo N. Resection rate of lung cancer in Teesside (UK) and Varese (Italy): a comparison after implementation of the National Cancer Plan. Thorax 2015; 71:230-7. [PMID: 26612687 DOI: 10.1136/thoraxjnl-2015-207572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In a lung cancer survey in 2000 we showed significantly less favourable stage distribution and lower resection rate in Teesside (UK) than in the comparable industrialised area of Varese (Italy). Lung cancer services in Teesside were subsequently reorganised according to National Cancer Plan recommendations. METHODS For all new lung cancer cases diagnosed in Teesside (n=324) and Varese (n=260) during the 12 months October 2010 to September 2011 (hereafter 'the 2010 cohort'), demographic, clinico-pathological and disease management data were prospectively recorded using the same database and protocol as the 2000 survey. Findings were analysed focusing on resection rate. RESULTS In the 2010 cohort compared with 2000, both in Teesside and Varese emergency referral decreased (p<0.001), performance status improved (p<0.001), but cancer stage shift was not seen; resection rate improved in Teesside, from 7% to 11% (p=0.054), and was unchanged in Varese (24%). Moreover, in Teesside compared with Varese the stage distribution remained less favourable, stage I-II non-small cell lung cancer (NSCLC) proportion being respectively 12% and 19% (p=0.040), and resection rate in all lung cancers remained lower (11% and 24%; p<0.001). On multivariate analysis, resection predictors in Teesside were as follows: stage I-II NSCLC (OR 86.14; 95% CI 31.80 to 233.37), performance status 0-1 (OR 5.02; 95% CI 1.48 to 17.07), belonging to 2010 cohort (OR 2.85; 95% CI 1.06 to 7.64). CONCLUSIONS In Teesside the main independent predictor of resection was disease stage; in 2010-2011 compared with 2000, lung cancer service improved but stage shift did not occur, and resection rate increased but remained significantly lower than in Varese.
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Affiliation(s)
- Andrea Imperatori
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Richard N Harrison
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Lorenzo Dominioni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Neil Leitch
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Elisa Nardecchia
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Vandana Jeebun
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Jacqueline Brown
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Elena Altieri
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Massimo Castiglioni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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