title: Lung cancer treatment is influenced by income, education, age and place of residence in a country with universal health coverage.
abstract: Selection of lung cancer treatment should be based on tumour characteristics, physiological reserves and preferences of the patient. Our aims were to identify and quantify other factors associated with treatment received. Lung cancer patient data from 2002 to 2011 were obtained from the national population-based Cancer Registry of Norway, Statistics Norway and the Norwegian Patient Register. Multivariable logistic regression examined whether year of diagnosis, age, sex, education, income, health trust, smoking status, extent of disease, histology and comorbidities were associated with choice of treatment; surgery or radical or palliative radiotherapy, within 1 year of diagnosis. Among the 24,324 lung cancer patients identified, the resection rate remained constant while the proportion of radical radiotherapy administered increased from 8.6 to 14.1%. Older patients, those with lower household incomes and certain health trusts were less likely to receive any treatment. Lower education and the male gender were identified as negative predictors for receiving surgery. Smoking history was positively associated with both radical and palliative radiotherapy, while comorbidity and symptoms were independently associated with receiving surgery and palliative radiotherapy. Although Norway is a highly egalitarian country with a free, universal healthcare system, this study indicates that surgery and radical and palliative radiotherapy were under-used among the elderly, those with a lower socioeconomic status and those living in certain health trusts.
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Yngvar
authors.initials: Y
authors.lastname: Nilssen
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Trond-Eirik
authors.initials: TE
authors.lastname: Strand
authors.affiliation: Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Fjellbirkeland
authors.affiliation: Division of Cardiothoracic and Respiratory Medicine, University Hospital North Norway, Tromsø, Norway.|Institute of Clinical Medicine, UiT -the Arctic University of Norway, Tromsø, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Bartnes
authors.affiliation: Department of Oncology, Oslo University Hospital - the Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Odd Terje
authors.initials: OT
authors.lastname: Brustugun
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.|School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.|School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Xue Qin
authors.initials: XQ
authors.lastname: Yu
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Møller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D012042:Registries; D012959:Socioeconomic Factors; D019472:Universal Health Insurance
keywords: lung cancer; national population-based; radiotherapy; surgery