title: Surgery and Surgical Consult Rates for Early Stage Lung Cancer in Ontario: A Population-Based Study.
abstract: BACKGROUND
  Surgery offers the best chance for survival for early (stage I and II) non-small cell lung cancer (NSCLC), but worldwide resection rates range from 49% to 77%. We investigated factors that may play a role in resection rates.
  
  
  METHODS
  Using administrative data, new diagnoses of NSCLC from 2010 through 2012 were captured. The rate of surgical consultation and resection overall and by age group were determined, as well as rates of pulmonary function testing and radiation therapy.
  
  
  RESULTS
  Of 4,309 persons diagnosed with stage I or II NSCLC between 2010 and 2012, 3,487 (80.9%) received surgical consultations, but only 58.9% (2,539) received surgery. Rates of consultation and surgery decreased with increasing patient age: only 60.3% of patients older than 80 received consultations and 29.9% had resections. Of the 1,770 patients who did not receive surgery, 948 (53.6%) received a surgical consultation, and in this group, 688 (72.5%) were treated with radiation. Of the 822 patients who did not see a surgeon, only 476 (57.9%) were treated with radiation. Pulmonary function testing was performed in 799 (84.3%) of patients who had surgical consults but in only 569 (69.2%) of those who did not see a surgeon.
  
  
  CONCLUSIONS
  Resection rates for early lung cancer appear low, which may be partly due to low rates of surgical consultation. Interestingly, patients who are seen by surgeons but who do not receive surgery are more likely to receive radiation than patients who are not referred for surgery. Further research is required to identify factors influencing resection rates.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bendzsak
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.affiliation: Department of Surgery and Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, and Division of General Surgery, University Health Network, Institute for Clinical Evaluative Science, Toronto, Ontario, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada. Electronic address: gail.darling@uhn.ca.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Darling
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009864:Ontario; D018579:Patient Selection; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome