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. 2015 Feb;70(2):161-8.
doi: 10.1136/thoraxjnl-2014-205692. Epub 2014 Oct 13.

What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?

Emma L O'Dowd  1 , Tricia M McKeever  1 , David R Baldwin  2 , Sadia Anwar  2 , Helen A Powell  1 , Jack E Gibson  1 , Barbara Iyen-Omofoman  2 , Richard B Hubbard  1
Affiliations
Free PMC article

What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?

Emma L O'Dowd et al. Thorax. 2015 Feb.
Free PMC article

Abstract

Background: The UK has poor lung cancer survival rates and high early mortality, compared to other countries. We aimed to identify factors associated with early death, and features of primary care that might contribute to late diagnosis.

Methods: All cases of lung cancer diagnosed between 2000 and 2013 were extracted from The Health Improvement Network database. Patients who died within 90 days of diagnosis were compared with those who survived longer. Standardised chest X-ray (CXR) and lung cancer rates were calculated for each practice.

Results: Of 20,142 people with lung cancer, those who died early consulted with primary care more frequently prediagnosis. Individual factors associated with early death were male sex (OR 1.17; 95% CI 1.10 to 1.24), current smoking (OR 1.43; 95% CI 1.28 to 1.61), increasing age (OR 1.80; 95% CI 1.62 to 1.99 for age ≥80 years compared to 65-69 years), social deprivation (OR 1.16; 95% CI 1.04 to 1.30 for Townsend quintile 5 vs 1) and rural versus urban residence (OR 1.22; 95% CI 1.06 to 1.41). CXR rates varied widely, and the odds of early death were highest in the practices which requested more CXRs. Lung cancer incidence at practice level did not affect early deaths.

Conclusions: Patients who die early from lung cancer are interacting with primary care prediagnosis, suggesting potentially missed opportunities to identify them earlier. A general increase in CXR requests may not improve survival; rather, a more timely and appropriate targeting of this investigation using risk assessment tools needs further assessment.

Keywords: Clinical Epidemiology; Lung Cancer.

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Figures

Figure 1
Figure 1
Flowchart of inclusion and exclusion criteria for the health improvement network (THIN) dataset.
Figure 2
Figure 2
Kaplan–Meier plot for the whole study population.
Figure 3
Figure 3
Age and sex-standardised chest X-ray rates per 100 population in the general practitioner practices studied.
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References

    1. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 2011;377:127–38. - PMC - PubMed
    1. Holmberg L, Sandin F, Bray F, et al. National comparisons of lung cancer survival in England, Norway and Sweden 2001–2004: differences occur early in follow-up. Thorax 2010;65:436–41. - PubMed
    1. Walters S, Maringe C, Coleman MP, et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007. Thorax 2013;68:551–64. - PubMed
    1. Lo Re V, III, Haynes K, Forde KA, et al. Validity of The Health Improvement Network (THIN) for epidemiologic studies of hepatitis C virus infection. Pharmacoepidemiol Drug Saf 2009;18:807–14. - PMC - PubMed
    1. Hall GC. Validation of death and suicide recording on the THIN UK primary care database. Pharmacoepidemiol Drug Saf 2009;18:120–31. - PubMed

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