title: Inequalities in non-small cell lung cancer treatment and mortality.
abstract: BACKGROUND
  Non-small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, and surgery is the preferred treatment for patients. The National Health Service established Primary Care Trusts (PCTs) in 2002 to manage local health needs. We investigate whether PCTs with a lower uptake of surgical treatment are those with above-average mortality 1 year after diagnosis. The applied methods can be used to monitor the performance of any administrative bodies responsible for the management of patients with cancer.
  
  
  METHODS
  All adults diagnosed with NSCLC lung cancer during 1998-2006 in England were identified. We fitted mixed effect logistic models to predict surgical treatment within 6 months after diagnosis, and mortality within 1 year of diagnosis.
  
  
  RESULTS
  Around 10% of the NCSLC patients received curative surgery. Older deprived patients and those who did not receive surgery had much higher odds of death 1 year after being diagnosed with cancer. In total, 69% of the PCTs were below the lower control limit of surgery and have predicted random intercepts above the mean value of zero of the random effect for mortality, whereas 40% were above the upper control limit of mortality within 1 year.
  
  
  CONCLUSIONS
  Our main results suggest the presence of clear geographical variation in the use of surgical treatment of NSCLC and mortality. Mixed-effects models combined with the funnel plot approach were useful for assessing the performance of PCTs that were above average in mortality and below average in surgery.
authors.affiliation: CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ula
authors.initials: U
authors.lastname: Nur
authors.affiliation: CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Manuela
authors.initials: M
authors.lastname: Quaresma
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Bianca
authors.initials: B
authors.lastname: De Stavola
authors.affiliation: National Cancer Intelligence Network, Public Health England, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Peake
authors.affiliation: CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rachet
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality* / Q000601:surgery; D004739:England / Q000453:epidemiology; D005260:Female; D005843:Geography; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D011320:Primary Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D012042:Registries; D017678:Sex Distribution; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: CANCER; Epidemiology of chronic non communicable diseases; MORTALITY