Inequalities in the utilisation of curative-intent treatments for early-stage non-small cell lung cancer across urban and rural areas: A population-based study in England

Abstract

Background

This study aims to assess sociodemographic inequalities in anticancer treatments including curative-intent surgery and curative-intent radiotherapy for people with early-stage non-small cell lung cancer (NSCLC), across urban and rural areas.

Methods

A total of 38,229 eligible patients with early-stage NSCLC were identified from the English cancer registry and information on anti-cancer treatment (curative-intent surgery, curative-intent radiotherapy, palliative treatment, no anticancer treatment) was extracted from linked data. Multinomial logistic regression models estimated the association of sociodemographic measures with receipt of anticancer treatments, adjusting for case-mix and travel time.

Results

Those living in more deprived areas were less likely to receive curative-intent surgery with a mean change in the estimated probability of −11.1 %age points (95 % CI −12.5;-9.6), but more likely to receive curative radiotherapy with a mean change of + 4.3 %age points (95 % CI 3.0;5.6), than those living in the least deprived areas. Compared to those living in the five largest cities, the estimated probability of receiving curative-intent surgery was lower for those living in other urban areas with a mean change of −2.7 %age points (95 % CI −3.7;-0.2), and those living in rural areas, with a mean change of −2.2 %age points (95 % CI −3.7;-0.6). The probability of receiving curative-intent radiotherapy was lower by on average −2.3 %age points (95 % CI −3.2;-1.3) for those living in other urban areas versus the largest cities, but the corresponding reduction for those living in rural areas was small (-0.5 %age points, 95 % CI −1.9;0.1).

Conclusion

There are major inequalities in receipt of curative-intent surgery for early-stage NSCLC according to deprivation, and urban versus rural residence with smaller inequalities for receipt of curative-intent radiotherapy.

Policy Implications

The further expansion of radiotherapy services could reduce inequalities in uptake of curative-intent treatment for NSCLC, but the impact on patient outcomes must be assessed.