Patients with localized non-small cell lung cancer miss out on curative surgery with distance from specialist care

Background: To determine whether increasing distance to the nearest accessible specialist hospital (NASH, a public hospital with a thoracic surgical service) increases a patient's likelihood of missing out on curative surgery for localized non-small cell lung cancer (NSCLC). Method: Population-based study of cancer registry records for 27033 people with lung cancer diagnosed in New South Wales, Australia, between 2000 and 2008 linked to hospital admission records. This analysis includes 3240 patients with localized NSCLC admitted to hospital within 12 months of diagnosis. Results: Patients who lived 100+km from the NASH were more likely to have no surgery (50.6%) than those living 0-39km away (37.6%) and more likely to attend general hospitals for their care (52.2% at 100+km, 14.8% at 0-39km). Relative to patients living 0-39km from the NASH and attending a specialist hospital for their care, the odds ratio (OR) of not having surgery was high if patients attended a general hospital (adjusted OR 5.99, 95% confidence interval (CI) 3.87-9.26, for those 0-39km distant) and even higher as distance from the NASH increased (24.68, 95% CI 12.37-49.13 for 40-49km and 30.10, 95% CI 18.2-49.40 for 100+km). For patients treated in specialist hospitals (public or private), the trend with distance was opposite: relative to 0-39 km, the OR was 0.29 (95% CI 0.15-0.50) at 40-99km and 0.14 (95% CI 0.08-0.26) at 100+km. Conclusions: Patients with localized NSCLC are most likely to have no potentially curative surgery if they live distant from a specialist hospital and attend a general hospital for their care.