title: Explaining inequalities in access to treatment in lung cancer.
abstract: BACKGROUND
  Geographical inequalities in lung cancer treatment and patient survival have been described. We hypothesized that lung cancer patients' access to treatment may be influenced by deprivation and the pathway to care.
  
  
  METHODS
  Case notes were reviewed for patients resident in south-east London who were registered with lung cancer at the Thames Cancer Registry in 1998. Use of surgery, chemotherapy, radiotherapy or any specific treatment and one-year survival were examined. Analyses were adjusted for age, sex, histology, stage and basis of diagnosis.
  
  
  RESULTS
  Data for 695 out of 958 (73%) patients were analysed. Subjects who were initially referred to a specialist in thoracic medicine, surgery or oncology were more likely to receive active treatment (71%) than subjects who were referred to other consultants (51%) or who were admitted as emergencies (42%) (P < 0.0001).
  
  
  CONCLUSIONS
  Socio-economic deprivation was associated with lower rates of treatment and this partly explained variations in survival. Subjects who were referred to specialists were more likely to receive active treatment and treatment patterns varied between first trust attended.
authors.affiliation: King's College London, Department of Public Health Services, London, UK. ruth.jack@kcl.ac.uk
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Jack
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
authors.forename: Jamie
authors.initials: J
authors.lastname: Ferguson
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008131:London; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013222:State Medicine / Q000458:organization & administration*