Cancer Epidemiol Biomarkers Prev. 2020 Sep 18:cebp.0709.2020. doi: 10.1158/1055-9965.EPI-20-0709. Online ahead of print.
BACKGROUND: Guideline-concordant treatment (GCT) of lung cancer has been observed to vary across geographic regions over the years. However, there is little evidence as to what extent this variation is explained by differences in patients’ clinical characteristics versus contextual factors, including socio-economic inequalities.
METHODS: This study evaluated the independent effects of individual and area-level risk factors on geographic and temporal variation in receipt of GCT among lung cancer patients. Receipt of GCT was defined based on the National Comprehensive Cancer Network (NCCN) guidelines. We used Bayesian spatial-temporal multi-level models to combine individual and areal predictors and outcomes while accounting for geographically-structured and unstructured correlation and linear and non-linear trends.
RESULTS: Our study included 4854 non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases, reported to the Victorian Lung Cancer Registry between 2011 and 2018. Area-level data comprised socio-economic disadvantage and remoteness data at the local government area level in Victoria, Australia. Around 60.36% of patients received GCT, and the rates varied across geographic areas over time. This variation was mainly associated with poor performance status, advanced clinical stages, NSCLC types, public hospital insurance, area-level deprivation, and comorbidities.
CONCLUSION: This study highlights the need to address disparities in receipt of GCT among lung cancer patients with poor performance status, NSCLC, advanced clinical stage, stage I-III-SCLC, stage III-NSCLC, public hospital insurance, comorbidities, and living in socio-economically disadvantaged areas.
IMPACT: Two-year mortality outcomes significantly improved with GCT. Interventions aimed at reducing these inequalities could help to improve lung cancer outcomes.