Educational level and management and outcomes in non-small cell lung cancer. A nationwide population-based study. (May 2019)

• Record Type: Journal Article
• Authors: Willén, Linda; Berglund, Anders; Bergström, Stefan; Bergqvist, Michael; Öjdahl-Bodén, Anna; Wagenius, Gunnar; Lambe, Mats
• Is Part Of: Lung cancer. Volume 131(2019)
• Page Start: 40
• Page End: 46
• Publication Date: 2019-05
• Subjects: Lung cancer -- Non-small cell lung cancer -- Socioeconomic status -- Educational status -- Population-based -- Sweden; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2019.03.004
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Educational level was not associated with stage at diagnosis or waiting times. The use of diagnostic methods and SBRT differed between educational groups. A socioeconomic gradient in mortality was observed in early stage disease. Observed differences may reflect use of novel diagnostic methods and treatments. Abstract: Objectives: We examined associations between educational level and clinical presentation, patterns of management and mortality in patients with non-small cell lung cancer (NSCLC) in Sweden, a country with a National Health Care System. Materials and Methods: We identified 39, 671 patients with a NSCLC diagnosis 2002–2016 in Lung Cancer Data Base Sweden (LCBaSe), a population-based research database. In analyses adjusted for comorbidity and other prognostic factors, odds Ratios (OR) and hazard Ratios (HR) were estimated to examine associations between patients' educational level and aspects of management and mortality. Results: Stage at diagnosis and waiting times did not differ between educational groups. In multivariable analysis, the likelihood to undergo PET/CT and assessment in a multidisciplinary team setting were higher in patients with high compared to low education (aOR 1.14; CI 1.05–1.23 and aOR 1.22; CI 1.14–1.32, respectively). In patients with early stage IA-IIB disease, the likelihood to undergo stereotactic radiotherapy was elevated in patients with high education (aOR 1.40; CI 1.03–1.91). Both all-cause (aHR 0.86; CI 0.77-0.92) and cause-specific mortality (aHR 0.83; CI 0.74-0.92) was lower in patients with high compared to low education in early stage disease (IA-IIB). In higher stage NSCLC no differences were observed. Patterns were similar in separate assessments stratified by sex and histopathology. Conclusions: While stage at diagnosis and waiting times did not differ between educational groups, we found socioeconomic differences in diagnostic intensity, multidisciplinary team assessment, stereotactic radiotherapy and mortality in patients with NSCLC. These findings may in part reflect social gradients in implementation and use of novel diagnostic and treatment modalities. Our findings underscore the need for improved adherence to national guidelines.