Social differences in lung cancer management and survival in South East England: a cohort study
- Anders Berglund1,2,
- Mats Lambe1,2,
- Margreet Lüchtenborg3,
- Karen Linklater3,
- Michael D Peake4,5,
- Lars Holmberg2,3,
- Henrik Møller3
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 2Regional Cancer Centre of Central Sweden, University Hospital, Uppsala, Sweden
- 3King's College London, School of Medicine, Division of Cancer Studies, Thames Cancer Registry, London, UK
- 4Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
- 5National Cancer Intelligence Network, London, UK
- Correspondence to Dr Anders Berglund;
- Received 24 February 2012
- Accepted 23 April 2012
- Published 25 May 2012
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.
Consent was not obtained but the presented data are anonymous and the risk of identification is low.
To cite: Berglund A, Lambe M, Lüchtenborg M, et al. Social differences in lung cancer management and survival in South East England: a cohort study. BMJ Open 2012;2:e001048. doi:10.1136/bmjopen-2012-001048
Contributors HM, LH, ML and AB designed and collected the data of the study. AB did the statistical analyses. All authors participated in interpretation of the data. AB wrote the first draft of the paper. All authors had full access to all the data and approved the final draft. HM is the guarantor for the study.
Funding AB was supported by a postgraduate scholarship from the Health Care Sciences Postgraduate School at Karolinska Institutet in Sweden. The funders of the study had no role in the design and conduct of the study; collection, management, analyses and interpretation of the results and preparation, review or approval of the manuscript. The funders did not have any involvement in the design of the study, the collection, analysis and interpretation of the data; the writing of the manuscript or the decision to submit the manuscript for publication.
Competing interests None.
Ethical approval The study was approved by the Research Ethics Committee at Karolinska Institute.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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