title: Patients with localized non-small cell lung cancer miss out on curative surgery with distance from specialist care.
abstract: BACKGROUND
  To determine whether increasing distance to the nearest accessible specialist hospital (NASH, a public hospital with a thoracic surgical service) increases a patient's likelihood of missing out on curative surgery for localized non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Population-based study of cancer registry records for 27 033 people with lung cancer diagnosed in New South Wales, Australia, between 2000 and 2008 linked to hospital admission records. This analysis includes 3240 patients with localized NSCLC admitted to hospital within 12 months of diagnosis.
  
  
  RESULTS
  Patients who lived 100+ km from the NASH were more likely to have no surgery (50.6%) than those living 0-39 km away (37.6%) and more likely to attend general hospitals for their care (52.2% at 100+ km, 14.8% at 0-39 km). Relative to patients living 0-39 km from the NASH and attending a specialist hospital for their care, the odds ratio (OR) of not having surgery was high if patients attended a general hospital (adjusted OR 5.99, 95% confidence interval (CI) 3.87-9.26, for those 0-39 km distant) and even higher as distance from the NASH increased (24.68, 95% CI 12.37-49.13 for 40-49 km and 30.10, 95% CI 18.2-49.40 for 100+ km). For patients treated in specialist hospitals (public or private), the trend with distance was opposite: relative to 0-39 km, the OR was 0.29 (95% CI 0.15-0.50) at 40-99 km and 0.14 (95% CI 0.08-0.26) at 100+ km.
  
  
  CONCLUSIONS
  Patients with localized NSCLC are most likely to have no potentially curative surgery if they live distant from a specialist hospital and attend a general hospital for their care.
authors.affiliation: Cancer Epidemiology Services Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tracey
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: McCaughan
authors.affiliation: Cancer Epidemiology Services Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Tim
authors.identifier: http://orcid.org/0000-0002-1275-1130
authors.initials: T
authors.lastname: Badgery-Parker
authors.affiliation: Cancer Epidemiology Services Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Young
authors.affiliation: Cancer Epidemiology Services Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006779:Hospitals, Public; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D011013:Pneumonectomy; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: access to health services; cancer registry; data linkage; distance to care; lung neoplasm; surgery