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Clin Transl Oncol. 2019 May;21(5):621-629. doi: 10.1007/s12094-018-1962-9. Epub 2018 Oct 19.

Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study.

Author information

1
Andalusian School of Public Health, Granada Cancer Registry, Campus Universitario de Cartuja, C/Cuesta del Observatorio 4, 18080, Granada, Spain.
2
Noncommunicable Diseases and Cancer Epidemiology Group, Biomedical Research Institute of Granada (ibs.Granada), University of Granada, Granada, Spain.
3
Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), ISCIII, Madrid, Spain, Madrid, Spain.
4
Regional Delegation of Equality, Health and Social Policies of Huelva, Huelva, Spain.
5
Andalusian Comprehensive Cancer Plan, Seville, Spain.
6
Radiotherapy and Oncology Department, Granada University Hospital Complex, Granada, Spain.
7
Huelva University Hospital Complex, Huelva, Spain.
8
Department of Preventive and Predictive Medicine, Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
9
Andalusian School of Public Health, Granada Cancer Registry, Campus Universitario de Cartuja, C/Cuesta del Observatorio 4, 18080, Granada, Spain. miguel.luque.easp@juntadeandalucia.es.
10
Noncommunicable Diseases and Cancer Epidemiology Group, Biomedical Research Institute of Granada (ibs.Granada), University of Granada, Granada, Spain. miguel.luque.easp@juntadeandalucia.es.
11
Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), ISCIII, Madrid, Spain, Madrid, Spain. miguel.luque.easp@juntadeandalucia.es.

Abstract

PURPOSE:

The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain.

METHODS:

A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain.

RESULTS:

There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis.

CONCLUSIONS:

The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.

KEYWORDS:

Cancer treatment; Excess risk; Hospital medical records; Lung cancer; Population-based cancer epidemiology; Survival analysis

PMID:
30341474
DOI:
10.1007/s12094-018-1962-9
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