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

O'Dowd, Emma L.; McKeever, Tricia M.; Baldwin, David R.; Anwar, Sadia; Powell, Helen A.; Gibson, Jack E.; Iyen-Omofoman, Barbara; Hubbard, Richard B.

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.

Citation

O'Dowd, E. L., McKeever, T. M., Baldwin, D. R., Anwar, S., Powell, H. A., Gibson, J. E., …Hubbard, R. B. (2015). What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?. Thorax, 70(2), https://doi.org/10.1136/thoraxjnl-2014-205692

• Journal Article Type: Article
• Acceptance Date: Aug 7, 2014
• Online Publication Date: Oct 13, 2014
• Publication Date: Jan 14, 2015
• Deposit Date: Jul 20, 2016
• Publicly Available Date: Jul 20, 2016
• Journal: Thorax
• Print ISSN: 0040-6376
• Electronic ISSN: 1468-3296
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 70
• Issue: 2
• DOI: https://doi.org/10.1136/thoraxjnl-2014-205692
• Keywords: Clinical Epidemiology ; Lung Cancer
• Public URL: https://nottingham-repository.worktribe.com/output/743292
• Publisher URL: http://thorax.bmj.com/content/70/2/161