Background:
Lung cancer treatment has improved in recent years; with earlier disease detection via the ?Liverpool Lung Project?, use of stereotactic ablative radiotherapy (SABR) and improved systemic therapeutics. Despite this the United Kingdom (UK) lags behind Europe in cancer outcomes. The ?wheel and spoke? structure of tertiary services may contribute to geographical variation in the provision of services, worsening outcomes for outlying populations.
Aim:
To assess the effect of distance to tertiary centre in lung cancer, at a UK three site Trust of District General Hospitals.
Methods:
This is a retrospective, observational study using UK national lung cancer audit data 2019-2021. All adult patients with biopsy proven lung cancer, or radiological diagnosis meeting criteria for radical treatment were included. Mesothelioma was excluded. Radical treatment candidates were identified, with distance calculated between patients? home address and relevant tertiary centre.
Results:
1,633 patients were included. 413 received radical treatment, 273 surgery or SABR. Characteristics between sites (A, B, and C) were similar; mean age (73.3, 73.4, 71.9), performance status (0.89, 0.81, 1.14), and ratio receiving radical treatment (0.23, 0.25, 0.26). Proportion of patients receiving SABR or surgery decreased (0.81, 0.58, 0.51) as distance from tertiary centre increased.
| Distance to tertiary centre (miles) | Number of patients | Patients receiving surgery | Intervention rate |
| 0-25 | 0 | 0 | - |
| 25.1-50 | 150 | 101 | 67% |
| 50.1-75 | 152 | 71 | 46% |
| 75.1-100 | 78 | 34 | 46% |
| >100 | 33 | 9 | 27% |
[Table 1] ? Operative rates by distance to tertiary centre.
Conclusion:
Patients further from treatment centres were less likely to receieve curative treamtment.