Distance from accessible specialist care and other determinants of advanced or unknown stage at diagnosis of people with non-small cell lung cancer: A data linkage study.

BACKGROUND: Access to specialist services may influence stage at cancer diagnosis and whether cancer is ever adequately staged. We investigated associations of distance to the nearest accessible specialist hospital (NASH) with likelihood of advanced or unknown stage cancer at diagnosis in Australian non-small cell lung cancer (NSCLC) patients.

METHODS: Cancer registry records for 22,260 consecutively diagnosed NSCLC patients, 11,147 with linked records of hospital admissions, were analysed. Distances from patients' homes to the NASH were measured using geographical coordinates. Multinomial logistic regression analysis examined associations of distance from the NASH, type of hospital of treatment and other characteristics of NSCLC patients with advanced and unknown cancer stage.

RESULTS: Odds of advanced stage and unknown stage NSCLC were higher in people who lived 40-99 km, OR 1.18 (95%CI 1.07-1.31) advanced stage and 1.18 (1.04-1.33) unknown stage, and 100 km+ from the NASH, OR 1.17 (1.08-1.27) advanced stage and OR 1.38 (1.25-1.52) unknown stage (reference group patients living 0-39 km from the NASH). For hospitalised patients likelihoods of advanced stage and unknown stage NSCLC were also significantly higher in patients treated in general hospitals than in those treated in specialist hospitals. When both distance and hospital type were considered, patients who lived 100 km+ from the NASH had low odds of unknown stage cancer if admitted to a specialist hospital, OR 0.63 (95%CI 0.47-0.85), but a high odds of unknown stage if admitted to a general hospital, OR 2.13 (1.78-2.54). These associations were independent of age, sex, socioeconomic status, comorbidity, period and method of diagnosis, and histopathological subtype.

CONCLUSIONS: People living remotely from accessible specialist services are at greatest risk of advanced stage or unknown stage disease if diagnosed with NSCLC. This risk is greater again if the patient is treated in a general hospital. Barriers to referral for specialist care require investigation.