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Title: Social differences in lung cancer management and survival in South East England: a cohort study
Authors: Berglund, Anders
Lambe, Mats
Luchtenborg, Margreet
Linklater, Karen
Peake, Michael D.
Holmberg, Lars
Møller, Henrik
First Published: 25-May-2012
Publisher: BMJ Publishing Group Ltd
Citation: BMJ Open, 2012, 2 : e001048
Abstract: Objective: To examine possible social variations in lung cancer survival and assess if any such gradients can be attributed to social differences in comorbidity, stage at diagnosis or treatment. Design: Population-based cohort identified in the Thames Cancer Registry. Setting: South East England. Participants: 15 582 lung cancer patients diagnosed between 2006 and 2008. Main outcome measures: Stage at diagnosis, surgery, radiotherapy, chemotherapy and survival. Results: The likelihood of being diagnosed as having early-stage disease did not vary by socioeconomic quintiles (p=0.58). In early-stage non-small-cell lung cancer, the likelihood of undergoing surgery was lowest in the most deprived group. There were no socioeconomic differences in the likelihood of receiving radiotherapy in stage III disease, while in advanced disease and in small-cell lung cancer, receipt of chemotherapy differed over socioeconomic quintiles (p<0.01). In early-stage disease and following adjustment for confounders, the HR between the most deprived and the most affluent group was 1.24 (95% CI 0.98 to 1.56). Corresponding estimates in stage III and advanced disease or small-cell lung cancer were 1.16 (95% CI 1.01 to 1.34) and 1.12 (95% CI 1.05 to 1.20), respectively. In early-stage disease, the crude HR between the most deprived and the most affluent group was approximately 1.4 and constant through follow-up, while in patients with advanced disease or small-cell lung cancer, no difference was detectable after 3 months. Conclusion: We observed socioeconomic variations in management and survival in patients diagnosed as having lung cancer in South East England between 2006 and 2008, differences which could not fully be explained by social differences in stage at diagnosis, co-morbidity and treatment. The survival observed in the most affluent group should set the target for what is achievable for all lung cancer patients, managed in the same healthcare system.
DOI Link: 10.1136/bmjopen-2012-001048
eISSN: 2044-6055
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2012 The authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (
Appears in Collections:Published Articles, Dept. of Health Sciences

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