Geographical inequalities in lung cancer management and survival in South East England: evidence of variation in access to oncology services?
Geographical inequalities in lung cancer management and survival in South East England: evidence of variation in access to oncology services?
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DOI：
10.1038/sj.bjc.6600831
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发表时间：
2003-04-07
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
--
作者：
本研究旨在确定英格兰东南部 26 个卫生当局对肺癌患者的治疗和生存情况是否存在差异。泰晤士癌症登记处确定了 1995 年至 1999 年间诊断为肺癌的患者（ICD-10 代码 C33-C34）。排除仅提供死亡证明的患者后，对 32 818 名 (81%) 患者进行了分析。卫生当局接受积极治疗的患者比例各不相同，接受非研究性手术的患者比例为 5% 至 17%，接受任何化疗的患者比例为 4% 至 17%，接受任何放射治疗的患者比例为 8% 至 30%，接受任何积极治疗的患者比例为 15% 至 42%。患者的一年生存率为 11% 至 34%。即使在调整病例组合后，也有证据表明卫生当局水平存在差异。首次住院是在放射治疗中心的患者更有可能接受积极治疗（OR 1.72，95% CI 1.21–2.46）、化疗（1.38，1.06–1.79）或放疗（1.86，1.28–2.71）。有证据表明，首次就诊在放射治疗中心的患者存活时间更长。这项研究表明，英格兰东南部肺癌患者的治疗和患者生存率存在地域不平等。有一些证据表明，这些不平等可能是由于获得肿瘤学服务的机会差异造成的。未来的研究应该调查这种情况下接受专科护理的途径和障碍。
This study aimed to determine whether the management and survival of patients with lung cancer varied among 26 health authorities in South East England. The Thames Cancer Registry identified patients diagnosed with lung cancer (ICD-10 codes C33–C34) between 1995 and 1999. After excluding death certificate only patients, 32 818 (81%) patients were analysed. The proportions of patients receiving active treatment varied among health authorities between 5 and 17% for non-investigative surgery, 4 and 17% for any chemotherapy, 8 and 30% for any radiotherapy and 15 and 42% for any active treatment. One-year patient survival ranged from 11 to 34%. There was evidence of health authority level variation even after adjusting for case mix. Patients whose first hospital attendance was at a radiotherapy centre were more likely to receive active treatment (OR 1.72, 95% CI 1.21–2.46), chemotherapy (1.38, 1.06–1.79) or radiotherapy (1.86, 1.28–2.71). There was some evidence that patients whose first hospital attendance was at a radiotherapy centre survived longer. This study shows there is geographical inequality in the treatment given to lung cancer patients and patient survival in South East England. There was some evidence to suggest that these inequalities might be explained by variations in access to oncology services. Future studies should investigate the pathways and barriers to specialist care in this condition.
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影响因子：
8.8
作者：
Melling, P P;Hatfield, A C;Muers, M F;Peake, M D;Storer, C J;Round, C E;Haward, R A;Crawford, S M
通讯作者：
Crawford, S M
影响因子：
120.7
作者：
Begg, CB;Cramer, LD;Brennan, MF
通讯作者：
Brennan, MF
DOI：
10.2307/2983325
发表时间：
1996-01-01
影响因子：
2
作者：
Goldstein, H;Spiegelhalter, DJ
通讯作者：
Spiegelhalter, DJ
影响因子：
10
作者：
Gregor, A;Thomson, CS;Milroy, R
通讯作者：
Milroy, R
影响因子：
10
作者：
Billing, JS;Wells, FC
通讯作者：
Wells, FC