title: Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study.
abstract: BACKGROUND
  The NHS Cancer Plan for England set waiting time targets for cancer referral (14 days from GP referral to first hospital appointment) and treatment (31 days from diagnosis, 62 days from urgent GP referral). Interim diagnostic intervals can also be calculated. The factors that influence timely post-primary care referral, diagnosis and treatment for lung cancer are not known.
  
  
  METHODS
  Northern and Yorkshire Cancer Registry, Hospital Episode Statistics and lung cancer audit data sets were linked. Logistic regression was used to investigate the factors (socioeconomic position, age, sex, histology, co-morbidity, year of diagnosis, stage and performance status (PS)) that may influence the likelihood of referral, diagnosis and treatment within target, for 28 733 lung cancer patients diagnosed in 2006-2010.
  
  
  RESULTS
  Late-stage, poor PS and small-cell histology were associated with a higher likelihood of post-primary care referral, diagnosis and treatment within target. Older patients were significantly less likely to receive treatment within the 31-day (odds ratio (OR)=0.79, 95% confidence interval (CI) 0.69-0.91) and 62-day target (OR=0.80, 95% CI 0.67-0.95) compared with younger patients.
  
  
  CONCLUSIONS
  Older patients waited longer for treatment and this may be unjustified. Patients who appeared ill were referred, diagnosed and treated more quickly and this 'sicker quicker' effect may cancel out system socioeconomic inequalities that might result in longer time intervals for more deprived patients.
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: L F
authors.initials: LF
authors.lastname: Forrest
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: J
authors.initials: J
authors.lastname: Adams
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: M
authors.initials: M
authors.lastname: White
authors.affiliation: 1] Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne NE2 4AX, UK [2] Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees TS17 6BH, UK.
authors.forename: G
authors.initials: G
authors.lastname: Rubin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D003625:Data Collection; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011320:Primary Health Care; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D061665:Time-to-Treatment