title: The disparity of health facilities in an urban area discourages proposed treatment application in inoperable lung cancer patients.
abstract: OBJECTIVE
  Patients with a newly diagnosed non-small cell lung cancer (NSCLC) stage IIIB are offered chemoradiotherapy, as proposed by the current guidelines. This combination treatment is facilitated by the coexistence of corresponding departments in the same establishment. The geographical disparity of these health facilities influences patients' willingness to be treated and may influence their survival. This is an observational study that compares the survival of two groups of patients with NSCLC stage IIIB: those treated with chemoradiotherapy versus those treated only with chemotherapy. These two comparable groups were formed exclusively by patients' and/or their families' decisions.
  
  
  METHODS
  One hundred fifteen consecutive NSCLC stage IIIB patients were included in the study. All were hospitalized in the biggest Chest Disease Hospital in Athens and were offered sequential chemoradiotherapy. Only 54 patients opted for the proposed treatment, while 61 decided to be treated with chemotherapy only, denying continuing their treatment in another health care unit (radiotherapy). Their survival and related factors were analyzed.
  
  
  RESULTS
  Mean overall survival was estimated 10 months (95% confidence interval [CI]: 7.96-12.04). Patients treated with chemoradiotherapy had almost double overall survival compared to those under chemotherapy (P = 0.001): 13.6 months (95% CI: 12.3-14.9) versus 7.5 (95% CI: 6.1-8.9). Patients aged ≤ 65 years (P < 0.001), smokers (P < 0.001), and those without a cancer history (P < 0.001) survived longer.
  
  
  CONCLUSIONS
  The lack of a radiotherapy department in a hospital providing chemotherapy impedes the application of current guidelines advocating combined radiochemotherapy. When recommended radiotherapy after six chemo cycles, half of the patients are unwilling to be displaced and do not follow the recommendations. This has an impact on patient survival.
authors.affiliation: Department of Respiratory and Critical Care Medicine, "Sotiria" Chest Diseases Hospital, Athens, Greece;
authors.forename: Georgios
authors.initials: G
authors.lastname: Hillas
authors.forename: Petros
authors.initials: P
authors.lastname: Bakakos
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Trichas
authors.forename: Fotis
authors.initials: F
authors.lastname: Vlastos