title: Geographic and socioeconomic factors in patients with malignant pleural mesothelioma in New South Wales and their impact upon clinical outcomes.
abstract: Whilst the impact of clinicopathological factors on the prognosis of malignant pleural mesothelioma (MPM) is well understood, socioeconomic and geographic factors have received less attention. We analysed the relationship between geographic and socioeconomic factors upon survival and treatment provision in a large series of patients with MPM.
  
  
  
  We assessed MPM patients awarded compensation between 2002 and 2009 with additional MPM incidence data from the New South Wales (NSW) Cancer Registry. The impact of geographic remoteness, distance from oncological multidisciplinary team (MDT) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) upon survival, clinical features and treatment received was analysed.
  
  
  
  We identified 910 patients (67% residing in major cities; 92% <50 km from MDT). Median overall survival was 10.0 months. On multivariate analysis, age >70 (hazard ratio (HR) = 1.39), male gender (HR =1.36), non-epithelioid histological subtype (HR = 2.18) and IRSAD status by decreasing quintile (HR = 1.06) were independent prognostic factors. There was no significant advantage for patients residing in major cities (10.6 months vs 8.8 months; P = 0.162) or within 50 km of MDT (10.3 months vs 7.8 months; P = 0.539). Patient's geographic location and distance to MDT did not impact chemotherapy, adjuvant radiotherapy or extrapleural pneumonectomy provision. Socioeconomically disadvantaged patients were significantly less likely to receive chemotherapy (37.4% vs 54.8%; P = 0.001).
  
  
  
  This study provides evidence for differences in the treatment and survival according to socioeconomic status for compensated MPM patients in NSW. Further research is warranted to seek additional explanations for the differences noted by comparing the treatments and outcomes of compensated and non-compensated MPM patients in NSW.
authors.affiliation: Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.|Concord Cancer Centre, Concord Hospital, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Linton
authors.affiliation: Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Soeberg
authors.affiliation: Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Broome
authors.affiliation: Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.|Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Kao
authors.affiliation: Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nico
authors.initials: N
authors.lastname: van Zandwijk
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011013:Pneumonectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012959:Socioeconomic Factors
keywords: asbestos; epidemiology; mesothelioma; socioeconomic status