title: Socio-economic inequalities in patient, primary care, referral, diagnostic, and treatment intervals on the lung cancer care pathway: protocol for a systematic review and meta-analysis.
abstract: BACKGROUND
  Early diagnosis and treatment of cancer is thought to be important for improving survival. Longer time between the onset of cancer symptoms and receipt of treatment may help explain the poorer survival of UK cancer patients compared to that in other countries.Socio-economic inequalities in receipt of, and time to, treatment may contribute to socio-economic differences in cancer survival. Socio-economic inequalities in receipt of lung cancer treatment have been shown in a recent systematic review. However, no systematic review of the evidence for socio-economic inequalities in time to presentation (patient interval), time to first investigation (primary care interval), time to secondary care investigation (referral interval), time to diagnosis (diagnostic interval), and time to treatment (treatment interval) has been conducted.This review aims to assess the published and grey literature evidence for socio-economic inequalities in the length of time spent on the lung cancer diagnostic and treatment pathway, examining interim intervals on the pathway where inequalities might occur.
  
  
  METHODS
  Systematic methods will be used to identify relevant studies, assess study eligibility for inclusion, and evaluate study quality. The online databases of MEDLINE, EMBASE, and CINAHL will be searched to locate cohort studies of adults with a primary diagnosis of lung cancer; where the outcome is mean or median time to the interval endpoint (or a suitable proxy measure of this), or the likelihood of longer or shorter time to the endpoint; analysed by a measure of socio-economic position. Meta-analysis will be conducted if there are sufficient studies available with suitable data.
  
  
  CONCLUSIONS
  This review will systematically determine if there are socio-economic inequalities in time from symptom onset to treatment for lung cancer. If such inequalities are present, our review evidence will help inform the development of interventions to reduce the time to diagnosis and treatment, ultimately helping to reduce socio-economic inequalities in survival.
  
  
  BACKGROUND
  PROSPERO CRD42014007145.
authors.affiliation: Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK. lynne.forrest2@ncl.ac.uk.
authors.forename: Lynne F
authors.initials: LF
authors.lastname: Forrest
authors.forename: Sarah
authors.initials: S
authors.lastname: Sowden
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.forename: Martin
authors.initials: M
authors.lastname: White
authors.forename: Jean
authors.initials: J
authors.lastname: Adams
mesh_terms: D019091:Critical Pathways / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic