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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

Estimated mortality rates by socioeconomic quintile (allowing socioeconomic quintile to vary by follow-up) and the HR between the most deprived versus the most affluent patients within 12 months of diagnosis by tumour subgroups using flexible parametric models. (A) Early-stage non-small-cell lung cancer (NSCLC) (mortality rate). (B) Stage III disease (mortality rate). (C) Advanced disease or small-cell lung cancer (SCLC) (mortality rate). (D) Early-stage NSCLC (HR). (E) Stage III disease (HR). (F) Advanced disease or SCLC (HR).
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fig2: Estimated mortality rates by socioeconomic quintile (allowing socioeconomic quintile to vary by follow-up) and the HR between the most deprived versus the most affluent patients within 12 months of diagnosis by tumour subgroups using flexible parametric models. (A) Early-stage non-small-cell lung cancer (NSCLC) (mortality rate). (B) Stage III disease (mortality rate). (C) Advanced disease or small-cell lung cancer (SCLC) (mortality rate). (D) Early-stage NSCLC (HR). (E) Stage III disease (HR). (F) Advanced disease or SCLC (HR).

Mentions: Figure 2 illustrates the variation in overall mortality rates by time since diagnosis in the five socioeconomic quintiles and the variation of HRs between the most deprived and the most affluent group. In early-stage non-small-cell lung cancer, socioeconomic variations in the mortality rates were most pronounced in the first months after diagnosis, but the differences persisted 12 months after diagnosis. A HR of approximately 1.4 between the most deprived and the most affluent group remained constant during the follow-up.


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)

Estimated mortality rates by socioeconomic quintile (allowing socioeconomic quintile to vary by follow-up) and the HR between the most deprived versus the most affluent patients within 12 months of diagnosis by tumour subgroups using flexible parametric models. (A) Early-stage non-small-cell lung cancer (NSCLC) (mortality rate). (B) Stage III disease (mortality rate). (C) Advanced disease or small-cell lung cancer (SCLC) (mortality rate). (D) Early-stage NSCLC (HR). (E) Stage III disease (HR). (F) Advanced disease or SCLC (HR).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Estimated mortality rates by socioeconomic quintile (allowing socioeconomic quintile to vary by follow-up) and the HR between the most deprived versus the most affluent patients within 12 months of diagnosis by tumour subgroups using flexible parametric models. (A) Early-stage non-small-cell lung cancer (NSCLC) (mortality rate). (B) Stage III disease (mortality rate). (C) Advanced disease or small-cell lung cancer (SCLC) (mortality rate). (D) Early-stage NSCLC (HR). (E) Stage III disease (HR). (F) Advanced disease or SCLC (HR).
Mentions: Figure 2 illustrates the variation in overall mortality rates by time since diagnosis in the five socioeconomic quintiles and the variation of HRs between the most deprived and the most affluent group. In early-stage non-small-cell lung cancer, socioeconomic variations in the mortality rates were most pronounced in the first months after diagnosis, but the differences persisted 12 months after diagnosis. A HR of approximately 1.4 between the most deprived and the most affluent group remained constant during the follow-up.

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