Author of

• 18749

  +

  P3.07 - Poster Session with Presenters Present (ID 493)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Regional Aspects/Health Policy/Public Health
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18760

    +

    P3.07-011 - Geographical Variation in the Use of Radiotherapy and Surgical Resection for Treatment of Non-Small Cell Lung Cancer in England (ID 6162)

    14:30 - 14:30  |  Author(s): R.H. Jack
    • Abstract

    Background:
    Despite global improvements in survival non-small cell lung cancer (NSCLC) remains lethal, with 20% five year survival in a limited number of developed nations. Fit, early stage NSCLC patients can be offered curative treatment, using surgery or radical radiotherapy. Geographical variation in surgery usage in England has previously been demonstrated. We aimed to further investigate this variation, incorporating all curative treatments and considering associated survival.
    
    Methods:
    Information on 143,886 patients diagnosed with a first NSCLC between April 2009 and December 2013 in England was extracted from the national cancer registration dataset linked to radiotherapy treatment and Hospital Episode Statistics data. In England Clinical Commissioning Groups (CCG) are the statutory bodies responsible for the planning and commissioning of health care services for their local area. We calculated the proportion of patients receiving curative treatment in each CCG, and created quintiles from the resulting distribution. Logistic regression was used to assess the effect of age, sex, stage, comorbidity, performance status and socio-economic deprivation on curative treatment usage. Multivariable Cox regression models were used to analyse survival in relation to curative treatment quintile.
    
    Results:
    Overall, 29,580 (20.6%) NSCLC patients received curative treatment: 20,177 (14.0%) NSCLC patients underwent resection and 9,403 (6.5%) received radical radiotherapy. The proportion of patients receiving curative treatments ranged from 11.8% to 31.7% across English CCGs and decreased with advancing age (p < 0.001), increasing stage (p < 0.001) and worsening performance status (p < 0.001). The proportion of patients receiving curative treatment was greater for females compared with males (p < 0.001). The absolute risk of dying within 5 years ranged from 90% in the lowest treatment quintile to 85% in the highest. Increasing curative treatment rates were associated with lower mortality (p < 0.001), with an adjusted HR of 0.93 (95% CI 0.92 to 0.95) in the highest treatment quintile compared with the lowest.
    
    Conclusion:
    Despite adjustment for case-mix variables we demonstrated that significant variation in the use of curative treatment for NSCLC persists across CCGs with increasing curative treatment rates associated with lower mortality. There is a need to further explore the factors driving this variation in order to guide changes in care which may deliver improved outcomes.