How do patient and hospital features influence outcomes in small cell lung cancer in England

Introduction: There is geographical variation in the delivery of active treatment in lung cancer. We wanted to find out whether the features of patients and/or NHS Trusts influence this variation. Methods: We linked the National Lung Cancer Audit and Hospital Episode Statistics and used multiple logistic and Cox regression analyses to assess the influence of patient and NHS Trust features on small cell lung cancer outcomes. Results: There were 87,252 patients, of whom 7,845 had histologically proven small cell lung cancer and 4820 (61%) received chemotherapy. Increasing age, worsening performance status, extensive stage and greater co-morbidity all significantly reduced the likelihood of receiving chemotherapy. Patients first seen in a “good” trial centre (defined as those entering >5% of expected patients into clinical trials) were 42% more likely to receive chemotherapy than those seen in other centres (adjusted OR 1.42, 95% CI 1.06, 1.90). Overall survival was lower in men, and as age, performance status, stage and co-morbidity increased prognosis worsened. Chemotherapy led to a 50% reduction in the likelihood of death (adjusted HR 0.48, 95% CI 0.42, 0.55), and in those patients who received chemotherapy, overall survival was not affected by where they were first seen. Conclusion: Chemotherapy clearly benefited overall survival, and patients first seen in an NHS Trust defined as a “good” trial centre had an increased likelihood of receiving chemotherapy without any adverse effect on survival. In order to ensure equal and safe access to treatment, the proportion of patients receiving chemotherapy in “poor” trial centres should increase to the level of “poor” trial centres.