Characterizing Regional Variability in Lung Cancer Outcomes across Ontario-A Population-Based Analysis.
Monica L MullinJonas P ShellenbergerMarlo WhiteheadMichael BrundageElizabeth A EisenhauerM Diane LougheedChristopher M ParkerGeneviève C DigbyPublished in: Current oncology (Toronto, Ont.) (2022)
Background : Lung cancer (LC) is the leading cause of cancer-related mortality. In Ontario, Canada, there are significant survival differences for patients with newly diagnosed LC across the 14 provincial regions. Methods : A population-based retrospective cohort study using ICES databases from 01/2007-12/2017 identified patients with newly diagnosed LC through the Ontario Cancer Registry and those with LC as the cause of death. Descriptive data included patient, disease, and system characteristics. The primary outcome was 5-year survival by region. Results : 178,202 patient records were identified; 101,263 met inclusion criteria. LC incidence varied by region (5.6-14.6/10,000), as did histologic subtype (adenocarcinoma: 27.3-46.1%). Five-year cancer-specific survival was impacted by age, rurality, pathologic subtype, stage at diagnosis, and income quintile. Timely care was inversely related to survival (fastest quintile: HR 3.22, p < 0.0001). Adjusted 5-year cancer-specific survival varied across regions (24.1%, HR 1.12; 34.0%, HR 0.89, p < 0.001). Conclusions : When adjusting for confounders, differences in survival by health region persisted, suggesting a complex interplay between patient, disease, and system factors. A single approach to improving patient care is likely to be ineffective across different systems. Quality improvement initiatives to improve patient outcomes require different approaches amongst health regions to address local disparities in care.
Keyphrases
- quality improvement
- healthcare
- newly diagnosed
- papillary thyroid
- free survival
- simultaneous determination
- mental health
- case report
- public health
- palliative care
- squamous cell carcinoma
- mass spectrometry
- physical activity
- cross sectional
- coronary artery disease
- type diabetes
- liquid chromatography
- metabolic syndrome
- health information
- risk factors
- pain management
- affordable care act
- risk assessment
- electronic health record
- artificial intelligence
- big data
- lymph node
- tandem mass spectrometry
- skeletal muscle
- climate change
- chronic pain
- tyrosine kinase
- solid phase extraction
- childhood cancer
- high resolution mass spectrometry