Overview of lung cancer surgery in Ontario.
BACKGROUND
Surgery is the primary curative treatment for lung cancer and thus appropriate surgical resource allocation is critical. This study describes the distribution of lung cancer incidence and surgical care in Ontario, a Canadian province with universal health care, for the fiscal year of 2004.


METHODS
All new lung cancer cases in Ontario between April 1, 2003 and March 31, 2004 were identified in the Ontario Cancer Registry. Incidence rates and surgical procedures were compared by age, health region, neighborhood income, and community size.


RESULTS
Lung cancer incidence was highest in lower income neighborhoods (90.2 cases of 100,000 vs 55.6 in the highest quintile, p < 0.001) and smaller communities (87.1 of 100,000 in communities less than 100,000 vs 56.3 of 100,000 in cities greater than 1.25 million, p < 0.001). Surgical interventions were most common in younger patients (47.4% aged 20 to 54 years versus 30.5% greater than 75 years, p < 0.001), and those in wealthier neighborhoods (43.4% in highest quintile versus 35.8% in the lowest, p < 0.001). Surgical procedures overall and specifically formal resections (20% in cities >1.25 million versus 18% in communities <100,000, p < 0.03) were more common in larger communities (43.4% versus 37.7%, p < 0.001). Pneumonectomy was more common in smaller communities (14.5% vs 9.9%, p = 0.048, whereas more lobar (53.8 vs 45.2%, p = 0.01) and sublobar resections (44.9% vs 31.7%, p < 0.0001) were more common in larger communities. Thoracic surgeons provided the majority of formal resections (51% to 57%) compared with general surgeons (17% to 21%).


CONCLUSIONS
Lung cancer incidence and surgical care vary significantly by health region, income level, and community size. These disparities require further evaluation to meet the needs of patients with lung cancer.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. anna.bendzsak@utoronto.ca
Anna
A
Bendzsak
Rahima
R
Nenshi
Gail
G
Darling
Susan E
SE
Schultz
Nadia
N
Gunraj
Andrew S
AS
Wilton
Marko
M
Simunovic
Binu
B
Jacob
David R
DR
Urbach
D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000379:methods / Q000706:statistics & numerical data; D006761:Hospitals / Q000145:classification; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008481:Mediastinoscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods; D018700:Pleurodesis / Q000706:statistics & numerical data; D011013:Pneumonectomy / Q000706:statistics & numerical data; D012042:Registries; D040841:Resource Allocation / Q000379:methods*; D012959:Socioeconomic Factors; D013903:Thoracic Surgery / Q000379:methods / Q000706:statistics & numerical data; D013906:Thoracoscopy / Q000706:statistics & numerical data; D013907:Thoracostomy / Q000706:statistics & numerical data; D055815:Young Adult