title: Survival of Australian lung cancer patients and the impact of distance from and attendance at a thoracic specialist centre: a data linkage study.
abstract: BACKGROUND
  Lung cancer patients have better survival when treated in thoracic surgical (specialist) centres.
  
  
  OBJECTIVE
  To determine whether outcome of non-small cell lung cancer (NSCLC) patients is poorer with increasing distance to the nearest accessible specialist hospital (NASH).
  
  
  METHODS
  We linked cancer registry, hospital and death records of 23,871 NSCLC patients; 3240 localised, 2435 regional and 3540 distant stage patients hospitalised within 12 months of diagnosis were analysed. Distance from patients' residences to the NASH was measured using geographical coordinates. Cox proportional hazards models examined predictors of NSCLC death.
  
  
  RESULTS
  Having a resection of the cancer, which admission to a specialist hospital made more likely, substantially reduced hazard of NSCLC death. Distance influenced hazard of death through both these variables; a patient was less likely to be admitted to a specialist hospital than a general hospital and less likely to have a resection the further they lived from the NASH. However, patients who lived distant from the NASH and were admitted to a specialist hospital were more likely to have a resection and less likely to die from NSCLC than patients admitted to a specialist hospital and living closer to the NASH. These patterns varied little with lung cancer stage.
  
  
  CONCLUSIONS
  NSCLC outcome is best when patients are treated in a specialist hospital. Greater distance to the NASH can affect its outcome by reducing the likelihood of being treated in a specialist hospital. Research is needed into patient and health service barriers to referral of NSCLC patients for specialist care.
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Elizabeth
authors: E
authors: Tracey
authors: Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors: Brian
authors: B
authors: McCaughan
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Tim
authors: http://orcid.org/0000-0002-1275-1130
authors: T
authors: Badgery-Parker
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Jane
authors: J
authors: Young
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Bruce
authors: B
authors: Armstrong
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003644:Death Certificates; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006753:Hospital Records; D006769:Hospitals, General / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008498:Medical Record Linkage; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D011013:Pneumonectomy / Q000706:statistics & numerical data; D012042:Registries; D015996:Survival Rate; D013903:Thoracic Surgery
keywords: Clinical Epidemiology; Non-Small Cell Lung Cancer; Thoracic Surgery