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Lung Cancer. 2018 Aug;122:171-179. doi: 10.1016/j.lungcan.2018.06.006. Epub 2018 Jun 9.

Patterns of care and emergency presentations for people with non-small cell lung cancer in New South Wales, Australia: A population-based study.

Author information

1
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia.
2
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia. Electronic address: davidg@nswcc.org.au.
3
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia; Ingham Institute, University of New South Wales, Liverpool, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, University of Western Sydney, Campbelltown, NSW, Australia.
4
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia; Sydney Catalyst, NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
5
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
6
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia.
7
Cancer Research Division, Cancer Council New South Wales, PO Box 572 Kings Cross, Sydney, NSW, 1340, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.

Abstract

INTRODUCTION:

Little is known about population-wide emergency presentations and patterns of care for people diagnosed with non-small cell lung cancer (NSCLC) in Australia. We examined patients' characteristics associated with presenting to an emergency department around the time of diagnosis ("emergency presenters"), and receiving anti-cancer treatment within 12 months of diagnosis.

MATERIALS AND METHODS:

Participants in the 45 and Up Study who were newly diagnosed with NSCLC during 2006-2010 were included. We used linked data from population-wide health databases including Medicare and pharmaceutical claims, inpatient hospitalisations and emergency department presentations to follow participants to June 2014. Patients' characteristics associated with being an emergency presenter and receiving any anti-cancer treatment were examined.

RESULTS:

A total of 647 NSCLC cases were included (58.6% male, median age 73 years). Emergency presenters (34.5% of cases) were more likely to have a high Charlson comorbidity index score, be an ex-smoker who had quit in the past 15 years and to be diagnosed with distant metastases. Almost all patients had visited their general practitioner ≥3 times in the 6 months prior to diagnosis. Nearly one-third (29.5%) of patients did not receive any anti-cancer treatment, however, there were no differences between emergency and non-emergency presenters in the likelihood of receiving treatment. Those less likely to be treated were older, had no private health insurance, and had unknown stage disease recorded.

CONCLUSION:

Our results indicate the difficulties in diagnosing lung cancer at an early stage and inequities in NSCLC treatment. Future research should address opportunities to diagnose lung cancer earlier and to optimise treatment pathways.

KEYWORDS:

Cancer treatment; Emergency presentation; Non-small cell lung cancer; Patterns of care

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