Hundreds of lung cancer patients may be dying prematurely every year as a result of disparities in rates of treatment across England, new research suggests.
The team behind the study say more than 800 patients a year could have their lives extended if the rates of treatment in the top 20% of areas were applied across the country.
“We are not talking about a few lives here, we are talking about something that matters,” said Prof Henrik Møller, head of cancer epidemiology and population health at King’s College London and first author of the research.
It is not the first time disparities in healthcare across the UK have been linked to cancer patients dying early, with previous research suggesting diagnosis and treatment is a “postcode lottery”.
The latest study, published in the journal Thorax, is based on statistics for more than 175,000 lung cancer patients in England diagnosed between 2010 and 2014.
The team looked at treatment rates across areas covered by former administrative bodies known as primary care trusts, and split them into five groups ranging from lowest to highest rates. Radiotherapy data, however, was not available for 2014.
For the lowest ranking of the five groups, the median rate was just 9.3% of patients receiving surgery, 4.0% receiving radical radiotherapy and 21.6% receiving chemotherapy, while the group with the highest rates had medians of 17.2% for surgery, 12.9% for radical radiotherapy and 34.5% for chemotherapy.
The team found the impact of such treatments on survival were strongest for particular stages of the disease, depending on treatment.
The results suggest that if all areas of the nation had the same level of surgery as those in the highest-ranking 20%, about 190 deaths could be avoided each year among those who had been diagnosed with early stage lung cancer within the previous two years.
Radical radiotherapy showed the strongest link to survival among those showing some local spread of the disease or for whom the stage was unknown, with the results suggesting that variation in treatment rates across England corresponds to a difference of about 370 people alive per year at two years after diagnosis. The variation in chemotherapy treatment rates was also linked to avoidable deaths.
The team say the figures were not affected by factors such as age, socioeconomic status or the presence of other illness.
Further analysis found that the point at which greater treatment leads to no further survival benefits has not yet been reached even for the highest treatment rates in England.
“The message is we treat our lung cancer patients too little and too passively, and existing therapies should be used more actively,” said Møller.
The study did not look at quality of life or longer-term outcomes, but the team say that as prognosis is poor for lung cancer patients it is appropriate to consider the short term.
While the analysis paints a picture of significant variation across England, the authors note that there is good news, pointing out that across the nation, survival of lung cancer patients was continuing to rise, with one-year survival increasing from 26% in 2005 to 36% in 2014, according to data analysed by the team. That, they note, is “remarkable progress”.
But they add that rates of treatment including surgical restriction are lower in England than in some other countries, such as Denmark, where one-year survival is 46%.
Professor Charles Swanton, Cancer Research UK’s chief clinician, said the analysis showed there was work to be done in bringing lung cancer care up to the highest standards around the nation, adding that the UK lags behind other European countries.
“Earlier diagnosis of lung cancer will play a major role in improving outcomes, as will ensuring optimal access to life-saving treatments including surgery, radiotherapy and medical therapies,” he said. “The NHS in England should continue to strive to overcome this devastating disease and provide patients with access to the best evidence-based treatments regardless of where they live.”
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