title: How do patient and hospital features influence outcomes in small-cell lung cancer in England?
abstract: BACKGROUND
  Our aim was to systematically determine how features of patients and hospitals influence access to chemotherapy and survival for people with small-cell lung cancer in England.
  
  
  METHODS
  We linked the National Lung Cancer Audit and Hospital Episode Statistics and used multiple logistic and Cox regression analyses to assess the influence of patient and hospital features on small-cell lung cancer outcomes.
  
  
  RESULTS
  There were 7845 patients with histologically proven small-cell lung cancer. Sixty-one percent (4820) of the patients received chemotherapy. Increasing age, worsening performance status, extensive stage and greater comorbidity all reduced the likelihood of receiving chemotherapy. There was wide variation in access to chemotherapy between hospitals in general and patients first seen in centres with a strong interest in clinical trials had a higher odds of receiving chemotherapy (adjusted odds ratio 1.42, 95% confidence interval (CI) 1.06, 1.90). Chemotherapy was associated with a lower mortality rate (adjusted hazard ratio 0.51, 95% CI 0.46, 0.56).
  
  
  CONCLUSIONS
  Patients first seen at a hospital with a keen interest in clinical trials are more likely to receive chemotherapy, and chemotherapy was associated with improved survival.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, England. anna.rich@nottingham.ac.uk
authors.forename: A L
authors.initials: AL
authors.lastname: Rich
authors.forename: L J
authors.initials: LJ
authors.lastname: Tata
authors.forename: C M
authors.initials: CM
authors.lastname: Free
authors.forename: R A
authors.initials: RA
authors.lastname: Stanley
authors.forename: M D
authors.initials: MD
authors.lastname: Peake
authors.forename: D R
authors.initials: DR
authors.lastname: Baldwin
authors.forename: R B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D015897:Comorbidity; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000401:mortality*; D016019:Survival Analysis