BACKGROUND: The 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. METHODS: All 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. RESULTS: There 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). CONCLUSION: A 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.
BACKGROUND: The 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. METHODS: All 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. RESULTS: There 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). CONCLUSION: A 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.
Authors: Jonathan M Harnoss; Rex Yung; Robert A Brodsky; Ralph H Hruban; John K Boitnott; David J Murphy; Stephen C Yang; Michael A Choti Journal: Am J Respir Crit Care Med Date: 2013-02-15 Impact factor: 21.405
Authors: Mariano Provencio; Enric Carcereny; Delvys Rodríguez-Abreu; Rafael López-Castro; María Guirado; Carlos Camps; Joaquim Bosch-Barrera; Rosario García-Campelo; Ana Laura Ortega-Granados; José Luis González-Larriba; Joaquín Casal-Rubio; Manuel Domine; Bartomeu Massutí; María Ángeles Sala; Reyes Bernabé; Juana Oramas; Elvira Del Barco Journal: Transl Lung Cancer Res Date: 2019-08
Authors: Emma L O'Dowd; Tricia M McKeever; David R Baldwin; Sadia Anwar; Helen A Powell; Jack E Gibson; Barbara Iyen-Omofoman; Richard B Hubbard Journal: Thorax Date: 2014-10-13 Impact factor: 9.139
Authors: Sarah Walters; Sara Benitez-Majano; Patrick Muller; Michel P Coleman; Claudia Allemani; John Butler; Mick Peake; Marianne Grønlie Guren; Bengt Glimelius; Stefan Bergström; Lars Påhlman; Bernard Rachet Journal: Br J Cancer Date: 2015-08-04 Impact factor: 7.640