Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014

doi:10.1038/s41416-018-0028-7

. 2018 May;118(10):1382-1390.

doi: 10.1038/s41416-018-0028-7. Epub 2018 May 10.

Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014

Katherine E Henson¹, Anna Fry^{2

3}, Georgios Lyratzopoulos^{2

4}, Michael Peake^{2

5

6}, Keith J Roberts⁷, Sean McPhail²

Affiliations

¹ National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK. katherine.henson@phe.gov.uk.
² National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK.
³ Cancer Research UK, Angel Building, London, EC1V 4AD, UK.
⁴ ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
⁵ University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
⁶ Centre for Cancer Outcomes, University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK.
⁷ Nuffield House, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, UK.

PMID: 29743552
PMCID: PMC5959922
DOI: 10.1038/s41416-018-0028-7

Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014

Katherine E Henson et al. Br J Cancer. 2018 May.

. 2018 May;118(10):1382-1390.

doi: 10.1038/s41416-018-0028-7. Epub 2018 May 10.

Authors

Katherine E Henson¹, Anna Fry^{2

3}, Georgios Lyratzopoulos^{2

4}, Michael Peake^{2

5

6}, Keith J Roberts⁷, Sean McPhail²

Affiliations

¹ National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK. katherine.henson@phe.gov.uk.
² National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK.
³ Cancer Research UK, Angel Building, London, EC1V 4AD, UK.
⁴ ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
⁵ University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
⁶ Centre for Cancer Outcomes, University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK.
⁷ Nuffield House, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, UK.

PMID: 29743552
PMCID: PMC5959922
DOI: 10.1038/s41416-018-0028-7

Abstract

Background: Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival.

Methods: We identified 50,232 patients with stage IV lung, oesophageal, pancreatic and stomach cancer from the English national cancer registry. A generalised linear model with a Poisson error structure was used to explore variation in radiotherapy and chemotherapy within 6 months from diagnosis by age, sex, deprivation, ethnicity, cancer site, comorbidity and, additionally, performance status.

Results: There was substantial variation by cancer site, large gradients by age, and non-trivial associations with comorbidity and deprivation. After full adjustment, more deprived patients were consistently least likely to be treated with chemotherapy alone or chemotherapy and radiotherapy combined compared with less deprived patients with equally advanced disease stage (treatment rate ratio: 0.82 95% CI (0.78, 0.87) for CT, 0.78 95% CI (0.71, 0.85) for CTRT p < 0.0001).

Conclusions: There was marked variation in the management of patients with stage IV cancer. Routinely collected data could be used for surveillance across all cancers to help reduce treatment variation and optimise outcomes among patients with advanced cancer.

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Conflict of interest statement

The authors declare no competing interests.

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References

1. Mellemgaard A, et al. Role of comorbidity on survival after radiotherapy and chemotherapy for nonsurgically treated lung cancer. J. Thorac. Oncol. 2015;10:272–279. doi: 10.1097/JTO.0000000000000416. - DOI - PubMed
1. Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br. J. Cancer. 2014;111:1843–1851. doi: 10.1038/bjc.2014.472. - DOI - PMC - PubMed
1. Ritzwoller DP, et al. Patterns and predictors of first-line chemotherapy use among adults with advanced non-small cell lung cancer in the cancer research network. Lung Cancer. 2012;78:245–252. doi: 10.1016/j.lungcan.2012.09.008. - DOI - PMC - PubMed
1. Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J. Palliat. Med. 2009;12:623–630. doi: 10.1089/jpm.2009.0036. - DOI - PMC - PubMed
1. Yang D, et al. Survival of metastatic gastric cancer: Significance of age, sex and race/ethnicity. J. Gastrointest. Oncol. 2011;2:77–84. - PMC - PubMed

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[1] Mellemgaard A, et al. Role of comorbidity on survival after radiotherapy and chemotherapy for nonsurgically treated lung cancer. J. Thorac. Oncol. 2015;10:272–279. doi: 10.1097/JTO.0000000000000416. - DOI - PubMed

[2] Mellemgaard A, et al. Role of comorbidity on survival after radiotherapy and chemotherapy for nonsurgically treated lung cancer. J. Thorac. Oncol. 2015;10:272–279. doi: 10.1097/JTO.0000000000000416. - DOI - PubMed

[3] Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br. J. Cancer. 2014;111:1843–1851. doi: 10.1038/bjc.2014.472. - DOI - PMC - PubMed

[4] Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br. J. Cancer. 2014;111:1843–1851. doi: 10.1038/bjc.2014.472. - DOI - PMC - PubMed

[5] Ritzwoller DP, et al. Patterns and predictors of first-line chemotherapy use among adults with advanced non-small cell lung cancer in the cancer research network. Lung Cancer. 2012;78:245–252. doi: 10.1016/j.lungcan.2012.09.008. - DOI - PMC - PubMed

[6] Ritzwoller DP, et al. Patterns and predictors of first-line chemotherapy use among adults with advanced non-small cell lung cancer in the cancer research network. Lung Cancer. 2012;78:245–252. doi: 10.1016/j.lungcan.2012.09.008. - DOI - PMC - PubMed

[7] Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J. Palliat. Med. 2009;12:623–630. doi: 10.1089/jpm.2009.0036. - DOI - PMC - PubMed

[8] Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. J. Palliat. Med. 2009;12:623–630. doi: 10.1089/jpm.2009.0036. - DOI - PMC - PubMed

[9] Yang D, et al. Survival of metastatic gastric cancer: Significance of age, sex and race/ethnicity. J. Gastrointest. Oncol. 2011;2:77–84. - PMC - PubMed

[10] Yang D, et al. Survival of metastatic gastric cancer: Significance of age, sex and race/ethnicity. J. Gastrointest. Oncol. 2011;2:77–84. - PMC - PubMed

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Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014

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Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014

Authors

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Abstract

Conflict of interest statement

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