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Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis

Background: Lung cancer (LC) is the leading cause of cancer-related mortality. In Ontario, Canada, there are significant survival differences for patients with newly diagnosed LC across the 14 provincial regions. Methods: A population-based retrospective cohort study using ICES databases from 01/200...

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Autores principales: Mullin, Monica L., Shellenberger, Jonas, Whitehead, Marlo, Brundage, Michael, Eisenhauer, Elizabeth A., Lougheed, M. Diane, Parker, Christopher M., Digby, Geneviève C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777041/
https://www.ncbi.nlm.nih.gov/pubmed/36547171
http://dx.doi.org/10.3390/curroncol29120757
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author Mullin, Monica L.
Shellenberger, Jonas
Whitehead, Marlo
Brundage, Michael
Eisenhauer, Elizabeth A.
Lougheed, M. Diane
Parker, Christopher M.
Digby, Geneviève C.
author_facet Mullin, Monica L.
Shellenberger, Jonas
Whitehead, Marlo
Brundage, Michael
Eisenhauer, Elizabeth A.
Lougheed, M. Diane
Parker, Christopher M.
Digby, Geneviève C.
author_sort Mullin, Monica L.
collection PubMed
description Background: Lung cancer (LC) is the leading cause of cancer-related mortality. In Ontario, Canada, there are significant survival differences for patients with newly diagnosed LC across the 14 provincial regions. Methods: A population-based retrospective cohort study using ICES databases from 01/2007–12/2017 identified patients with newly diagnosed LC through the Ontario Cancer Registry and those with LC as the cause of death. Descriptive data included patient, disease, and system characteristics. The primary outcome was 5-year survival by region. Results: 178,202 patient records were identified; 101,263 met inclusion criteria. LC incidence varied by region (5.6–14.6/10,000), as did histologic subtype (adenocarcinoma: 27.3–46.1%). Five-year cancer-specific survival was impacted by age, rurality, pathologic subtype, stage at diagnosis, and income quintile. Timely care was inversely related to survival (fastest quintile: HR 3.22, p < 0.0001). Adjusted 5-year cancer-specific survival varied across regions (24.1%, HR 1.12; 34.0%, HR 0.89, p < 0.001). Conclusions: When adjusting for confounders, differences in survival by health region persisted, suggesting a complex interplay between patient, disease, and system factors. A single approach to improving patient care is likely to be ineffective across different systems. Quality improvement initiatives to improve patient outcomes require different approaches amongst health regions to address local disparities in care.
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spelling pubmed-97770412022-12-23 Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis Mullin, Monica L. Shellenberger, Jonas Whitehead, Marlo Brundage, Michael Eisenhauer, Elizabeth A. Lougheed, M. Diane Parker, Christopher M. Digby, Geneviève C. Curr Oncol Article Background: Lung cancer (LC) is the leading cause of cancer-related mortality. In Ontario, Canada, there are significant survival differences for patients with newly diagnosed LC across the 14 provincial regions. Methods: A population-based retrospective cohort study using ICES databases from 01/2007–12/2017 identified patients with newly diagnosed LC through the Ontario Cancer Registry and those with LC as the cause of death. Descriptive data included patient, disease, and system characteristics. The primary outcome was 5-year survival by region. Results: 178,202 patient records were identified; 101,263 met inclusion criteria. LC incidence varied by region (5.6–14.6/10,000), as did histologic subtype (adenocarcinoma: 27.3–46.1%). Five-year cancer-specific survival was impacted by age, rurality, pathologic subtype, stage at diagnosis, and income quintile. Timely care was inversely related to survival (fastest quintile: HR 3.22, p < 0.0001). Adjusted 5-year cancer-specific survival varied across regions (24.1%, HR 1.12; 34.0%, HR 0.89, p < 0.001). Conclusions: When adjusting for confounders, differences in survival by health region persisted, suggesting a complex interplay between patient, disease, and system factors. A single approach to improving patient care is likely to be ineffective across different systems. Quality improvement initiatives to improve patient outcomes require different approaches amongst health regions to address local disparities in care. MDPI 2022-12-07 /pmc/articles/PMC9777041/ /pubmed/36547171 http://dx.doi.org/10.3390/curroncol29120757 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mullin, Monica L.
Shellenberger, Jonas
Whitehead, Marlo
Brundage, Michael
Eisenhauer, Elizabeth A.
Lougheed, M. Diane
Parker, Christopher M.
Digby, Geneviève C.
Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title_full Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title_fullStr Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title_full_unstemmed Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title_short Characterizing Regional Variability in Lung Cancer Outcomes across Ontario—A Population-Based Analysis
title_sort characterizing regional variability in lung cancer outcomes across ontario—a population-based analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777041/
https://www.ncbi.nlm.nih.gov/pubmed/36547171
http://dx.doi.org/10.3390/curroncol29120757
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