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 27 033 people with lung cancer diagnosed in N ew S outh W ales, A ustralia, 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 0–39 km away (37.6%) and more likely to attend general hospitals for their care (52.2% at 100+ km, 14.8% at 0–39 km). Relative to patients living 0–39 km 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 0–39 km distant) and even higher as distance from the NASH increased (24.68, 95% CI 12.37–49.13 for 40–49 km 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 40–99 km 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.