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Social differences in lung cancer management and survival in South East England: a cohort study.

Berglund A, Lambe M, Lüchtenborg M, Linklater K, Peake MD, Holmberg L, Møller H - BMJ Open (2012)

Bottom Line: The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58).In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56).In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: To examine possible social variations in lung cancer survival and assess if any such gradients can be attributed to social differences in comorbidity, stage at diagnosis or treatment.

Design: Population-based cohort identified in the Thames Cancer Registry.

Setting: South East England.

Participants: 15 582 lung cancer patients diagnosed between 2006 and 2008.

Main outcome measures: Stage at diagnosis, surgery, radiotherapy, chemotherapy and survival.

Results: The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58). In early-stage non-small-cell lung cancer, the likelihood of undergoing surgery was lowest in the most deprived group. There were no socioeconomic differences in the likelihood of receiving radiotherapy in stage III disease, while in advanced disease and in small-cell lung cancer, receipt of chemotherapy differed over socioeconomic quintiles (p<0.01). In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56). Corresponding estimates in stage III and advanced disease or small-cell lung cancer were 1.16 (95% CI 1.01 to 1.34) and 1.12 (95% CI 1.05 to 1.20), respectively. In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months.

Conclusion: We observed socioeconomic variations in management and survival in patients diagnosed as having lung cancer in South East England between 2006 and 2008, differences which could not fully be explained by social differences in stage at diagnosis, co-morbidity and treatment. The survival observed in the most affluent group should set the target for what is achievable for all lung cancer patients, managed in the same healthcare system.

No MeSH data available.


Related in: MedlinePlus

Cumulative survival estimated by flexible parametric models by tumour subgroups and socioeconomic quintile. (A) Early-stage non-small-cell lung cancer (NSCLC). (B) Stage III disease. (C) Advanced disease or small-cell lung cancer (SCLC).
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fig1: Cumulative survival estimated by flexible parametric models by tumour subgroups and socioeconomic quintile. (A) Early-stage non-small-cell lung cancer (NSCLC). (B) Stage III disease. (C) Advanced disease or small-cell lung cancer (SCLC).

Mentions: Figure 1 shows estimated cumulative survival functions by socioeconomic quintile generated by flexible parametric models. In patients with early-stage non-small-cell lung cancer, the 3-year survival in the most affluent and the most deprived group was 50% and 39%, respectively. While survival in stage III disease and in advanced disease or small-cell lung cancer was poor in all socioeconomic quintiles, the prognosis was somewhat better in the most affluent group.


Social differences in lung cancer management and survival in South East England: a cohort study.

Berglund A, Lambe M, Lüchtenborg M, Linklater K, Peake MD, Holmberg L, Møller H - BMJ Open (2012)

Cumulative survival estimated by flexible parametric models by tumour subgroups and socioeconomic quintile. (A) Early-stage non-small-cell lung cancer (NSCLC). (B) Stage III disease. (C) Advanced disease or small-cell lung cancer (SCLC).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3367157&req=5

fig1: Cumulative survival estimated by flexible parametric models by tumour subgroups and socioeconomic quintile. (A) Early-stage non-small-cell lung cancer (NSCLC). (B) Stage III disease. (C) Advanced disease or small-cell lung cancer (SCLC).
Mentions: Figure 1 shows estimated cumulative survival functions by socioeconomic quintile generated by flexible parametric models. In patients with early-stage non-small-cell lung cancer, the 3-year survival in the most affluent and the most deprived group was 50% and 39%, respectively. While survival in stage III disease and in advanced disease or small-cell lung cancer was poor in all socioeconomic quintiles, the prognosis was somewhat better in the most affluent group.

Bottom Line: The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58).In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56).In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: To examine possible social variations in lung cancer survival and assess if any such gradients can be attributed to social differences in comorbidity, stage at diagnosis or treatment.

Design: Population-based cohort identified in the Thames Cancer Registry.

Setting: South East England.

Participants: 15 582 lung cancer patients diagnosed between 2006 and 2008.

Main outcome measures: Stage at diagnosis, surgery, radiotherapy, chemotherapy and survival.

Results: The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58). In early-stage non-small-cell lung cancer, the likelihood of undergoing surgery was lowest in the most deprived group. There were no socioeconomic differences in the likelihood of receiving radiotherapy in stage III disease, while in advanced disease and in small-cell lung cancer, receipt of chemotherapy differed over socioeconomic quintiles (p<0.01). In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56). Corresponding estimates in stage III and advanced disease or small-cell lung cancer were 1.16 (95% CI 1.01 to 1.34) and 1.12 (95% CI 1.05 to 1.20), respectively. In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months.

Conclusion: We observed socioeconomic variations in management and survival in patients diagnosed as having lung cancer in South East England between 2006 and 2008, differences which could not fully be explained by social differences in stage at diagnosis, co-morbidity and treatment. The survival observed in the most affluent group should set the target for what is achievable for all lung cancer patients, managed in the same healthcare system.

No MeSH data available.


Related in: MedlinePlus