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Inequalities in non-small cell lung cancer treatment and mortality

BACKGROUND: Non-small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, and surgery is the preferred treatment for patients. The National Health Service established Primary Care Trusts (PCTs) in 2002 to manage local health needs. We investigate whether PCTs with a lower...

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Autores principales: Nur, Ula, Quaresma, Manuela, De Stavola, Bianca, Peake, Michael, Rachet, Bernard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602267/
https://www.ncbi.nlm.nih.gov/pubmed/26047831
http://dx.doi.org/10.1136/jech-2014-205309
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author Nur, Ula
Quaresma, Manuela
De Stavola, Bianca
Peake, Michael
Rachet, Bernard
author_facet Nur, Ula
Quaresma, Manuela
De Stavola, Bianca
Peake, Michael
Rachet, Bernard
author_sort Nur, Ula
collection PubMed
description BACKGROUND: Non-small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, and surgery is the preferred treatment for patients. The National Health Service established Primary Care Trusts (PCTs) in 2002 to manage local health needs. We investigate whether PCTs with a lower uptake of surgical treatment are those with above-average mortality 1 year after diagnosis. The applied methods can be used to monitor the performance of any administrative bodies responsible for the management of patients with cancer. METHODS: All adults diagnosed with NSCLC lung cancer during 1998–2006 in England were identified. We fitted mixed effect logistic models to predict surgical treatment within 6 months after diagnosis, and mortality within 1 year of diagnosis. RESULTS: Around 10% of the NCSLC patients received curative surgery. Older deprived patients and those who did not receive surgery had much higher odds of death 1 year after being diagnosed with cancer. In total, 69% of the PCTs were below the lower control limit of surgery and have predicted random intercepts above the mean value of zero of the random effect for mortality, whereas 40% were above the upper control limit of mortality within 1 year. CONCLUSIONS: Our main results suggest the presence of clear geographical variation in the use of surgical treatment of NSCLC and mortality. Mixed-effects models combined with the funnel plot approach were useful for assessing the performance of PCTs that were above average in mortality and below average in surgery.
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spelling pubmed-46022672015-10-21 Inequalities in non-small cell lung cancer treatment and mortality Nur, Ula Quaresma, Manuela De Stavola, Bianca Peake, Michael Rachet, Bernard J Epidemiol Community Health Other Topics BACKGROUND: Non-small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, and surgery is the preferred treatment for patients. The National Health Service established Primary Care Trusts (PCTs) in 2002 to manage local health needs. We investigate whether PCTs with a lower uptake of surgical treatment are those with above-average mortality 1 year after diagnosis. The applied methods can be used to monitor the performance of any administrative bodies responsible for the management of patients with cancer. METHODS: All adults diagnosed with NSCLC lung cancer during 1998–2006 in England were identified. We fitted mixed effect logistic models to predict surgical treatment within 6 months after diagnosis, and mortality within 1 year of diagnosis. RESULTS: Around 10% of the NCSLC patients received curative surgery. Older deprived patients and those who did not receive surgery had much higher odds of death 1 year after being diagnosed with cancer. In total, 69% of the PCTs were below the lower control limit of surgery and have predicted random intercepts above the mean value of zero of the random effect for mortality, whereas 40% were above the upper control limit of mortality within 1 year. CONCLUSIONS: Our main results suggest the presence of clear geographical variation in the use of surgical treatment of NSCLC and mortality. Mixed-effects models combined with the funnel plot approach were useful for assessing the performance of PCTs that were above average in mortality and below average in surgery. BMJ Publishing Group 2015-10 2015-06-05 /pmc/articles/PMC4602267/ /pubmed/26047831 http://dx.doi.org/10.1136/jech-2014-205309 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Other Topics
Nur, Ula
Quaresma, Manuela
De Stavola, Bianca
Peake, Michael
Rachet, Bernard
Inequalities in non-small cell lung cancer treatment and mortality
title Inequalities in non-small cell lung cancer treatment and mortality
title_full Inequalities in non-small cell lung cancer treatment and mortality
title_fullStr Inequalities in non-small cell lung cancer treatment and mortality
title_full_unstemmed Inequalities in non-small cell lung cancer treatment and mortality
title_short Inequalities in non-small cell lung cancer treatment and mortality
title_sort inequalities in non-small cell lung cancer treatment and mortality
topic Other Topics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602267/
https://www.ncbi.nlm.nih.gov/pubmed/26047831
http://dx.doi.org/10.1136/jech-2014-205309
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