title: Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service.
abstract: BACKGROUND
  The treatment given to patients with lung cancer and survival vary between and within countries. The National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics was used to quantify the extent to which these outcomes are influenced by patient features and/or hospital facilities and performance indicators.
  
  
  METHODS
  All patients with a histological diagnosis of non-small cell lung cancer (NSCLC) were included. Logistic regression was used to quantify the independent influence of features of both patients and hospitals on the likelihood of having surgery and Cox regression was used for survival analyses.
  
  
  RESULTS
  There were 34,513 patients with NSCLC in our dataset. After adjusting for age, sex, performance status, stage and Charlson Index of comorbidity, patients with NSCLC first seen in thoracic surgical centres (27% of the cohort) were 51% more likely to have surgery than those seen in non-surgical centres (adjusted OR 1.51, 95% CI 1.16 to 1.97). Resection rates varied from 13% to 17% between non-surgical and thoracic surgical centres. Surgery was the most powerful determinant of overall survival (adjusted HR 0.41, 95% CI 0.39 to 0.44).
  
  
  CONCLUSIONS
  A minority of patients with NSCLC first seen in a thoracic surgical centre are more likely to have surgery and to benefit from the survival advantage this confers. This finding suggests that there is an opportunity to improve the outcome for patients with lung cancer in England by optimising access to thoracic surgeons in non-surgical centres.
authors.affiliation: Clinical Sciences Building, City Campus, Hucknall Road, Nottingham NH5 1PB, UK. anna.rich@nottingham.ac.uk
authors.forename: Anna L
authors.initials: AL
authors.lastname: Rich
authors.forename: Laila J
authors.initials: LJ
authors.lastname: Tata
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Free
authors.forename: Rosamund A
authors.initials: RA
authors.lastname: Stanley
authors.forename: Michael D
authors.initials: MD
authors.lastname: Peake
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D016019:Survival Analysis; D016896:Treatment Outcome