BACKGROUND: Lung cancer patients have better survival when treated in thoracic surgical (specialist) centres. AIMS: To determine whether outcome of non-small cell lung cancer (NSCLC) patients is poorer with increasing distance to the nearest accessible specialist hospital (NASH). METHODS: We linked cancer registry, hospital and death records of 23,871 NSCLC patients; 3240 localised, 2435 regional and 3540 distant stage patients hospitalised within 12 months of diagnosis were analysed. Distance from patients' residences to the NASH was measured using geographical coordinates. Cox proportional hazards models examined predictors of NSCLC death. RESULTS: Having a resection of the cancer, which admission to a specialist hospital made more likely, substantially reduced hazard of NSCLC death. Distance influenced hazard of death through both these variables; a patient was less likely to be admitted to a specialist hospital than a general hospital and less likely to have a resection the further they lived from the NASH. However, patients who lived distant from the NASH and were admitted to a specialist hospital were more likely to have a resection and less likely to die from NSCLC than patients admitted to a specialist hospital and living closer to the NASH. These patterns varied little with lung cancer stage. CONCLUSIONS: NSCLC outcome is best when patients are treated in a specialist hospital. Greater distance to the NASH can affect its outcome by reducing the likelihood of being treated in a specialist hospital. Research is needed into patient and health service barriers to referral of NSCLC patients for specialist care. 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.
BACKGROUND:Lung cancerpatients have better survival when treated in thoracic surgical (specialist) centres. AIMS: To determine whether outcome of non-small cell lung cancer (NSCLC) patients is poorer with increasing distance to the nearest accessible specialist hospital (NASH). METHODS: We linked cancer registry, hospital and death records of 23,871 NSCLCpatients; 3240 localised, 2435 regional and 3540 distant stage patients hospitalised within 12 months of diagnosis were analysed. Distance from patients' residences to the NASH was measured using geographical coordinates. Cox proportional hazards models examined predictors of NSCLC death. RESULTS: Having a resection of the cancer, which admission to a specialist hospital made more likely, substantially reduced hazard of NSCLC death. Distance influenced hazard of death through both these variables; a patient was less likely to be admitted to a specialist hospital than a general hospital and less likely to have a resection the further they lived from the NASH. However, patients who lived distant from the NASH and were admitted to a specialist hospital were more likely to have a resection and less likely to die from NSCLC than patients admitted to a specialist hospital and living closer to the NASH. These patterns varied little with lung cancer stage. CONCLUSIONS:NSCLC outcome is best when patients are treated in a specialist hospital. Greater distance to the NASH can affect its outcome by reducing the likelihood of being treated in a specialist hospital. Research is needed into patient and health service barriers to referral of NSCLCpatients for specialist care. 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.
Entities:
Keywords:
Clinical Epidemiology; Non-Small Cell Lung Cancer; Thoracic Surgery
Authors: Meredith A Ray; Nicholas R Faris; Anna Derrick; Matthew P Smeltzer; Raymond U Osarogiagbon Journal: Chest Date: 2020-05-06 Impact factor: 9.410
Authors: J Dunn; G Garvey; P C Valery; D Ball; K M Fong; S Vinod; D L O'Connell; S K Chambers Journal: Support Care Cancer Date: 2016-10-10 Impact factor: 3.603