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Educational level and management and outcomes in non-small cell lung cancer. A nationwide population-based study
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden.ORCID iD: 0000-0003-2916-778X
Epistat, Uppsala.
Centrum för forskning och utveckling Region Gävleborg.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Center for Research and Development, Uppsala University/Region Gävleborg, Sweden; Department of Oncology, Gävle Hospital, Gävle, Sweden.ORCID iD: 0000-0003-1351-5153
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2019 (English)In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 131, p. 40-46Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 131, p. 40-46
Keywords [en]
Lung cancer, Non-small cell lung cancer, Socioeconomic status, Educational status, Population-based, Sweden
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-159536DOI: 10.1016/j.lungcan.2019.03.004ISI: 000468721500006PubMedID: 31027696OAI: oai:DiVA.org:umu-159536DiVA, id: diva2:1319216
Funder
Swedish Cancer Society, 15-0804Swedish Cancer Society, 18-0689Available from: 2019-05-30 Created: 2019-05-30 Last updated: 2019-06-17Bibliographically approved

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Willén, LindaBergqvist, Michael

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