Social and geographical factors affecting access to treatment of lung cancer

BACKGROUND: UK residents' healthcare is free of charge but uptake varies. Cancer survival is inferior to that of other Western European countries. We have used cancer registry data to assess factors associated with access to diagnosis and treatment of lung cancer in northern England. METHOD: We assigned 34 923 lung cancer patients diagnosed between 1994 and 2002 to quartiles for the deprivation score associated with their postcode and for the travel time to the relevant healthcare facility. Odds ratios, adjusted for age and sex, for undergoing interventions were calculated relative to the least deprived quartile living closest to the facility. The odds ratio for receiving chemotherapy for small-cell lung cancer (SCLC) was calculated according to the type of hospital where it was diagnosed. RESULTS: The odds ratio for attainment of a histological diagnosis for the least deprived/furthest residence group was 0.83 (95% confidence 0.70–0.97) for the most deprived/nearest residence group was 0.74(0.62–0.87) and for the most deprived/furthest residence group it was 0.61 (0.49–0.75). The corresponding odds ratios for receipt of any active treatment were 0.93 (0.80–1.07), 0.74 (0.64–0.86), and 0.55 (0.46–0.67). The odds ratios for receipt of chemotherapy for SCLC were 1.27 (0.89–1.82), 1.21 (0.85–1.74) and 0.81 (0.52–1.28). Odds ratios for undergoing surgery for non-small cell lung cancer using (1) travel time to diagnosing hospital were 0.88 (0.70–1.11), 0.74 (0.59–0.94) and 0.60 (0.44–0.84). Using (2) travel time to a thoracic surgery facility they were 0.83 (0.65–1.06), 0.70 (0.55–0.89) and 0.55 (0.49–0.76). CONCLUSION: Living in a deprived locality reduces the likelihood of undergoing definitive management for lung cancer with the exception of chemotherapy for SCLC. This is amplified by travel time to services.