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Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study

Lookup NU author(s): Dr Lynne Forrest, Dr Jean Adams, Professor Martin White, Emeritus Professor Greg RubinORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).


Background The NHS Cancer Plan for England set waiting time targets for cancer referral [14 days from GP referral to first hospital appointment] and treatment [31 days from diagnosis, 62 days from urgent GP referral]. Interim diagnostic intervals can also be calculated. The factors that influence timely post-primary care referral, diagnosis and treatment for lung cancer are not known. Methods Northern and Yorkshire cancer registry, Hospital Episode Statistics and lung cancer audit data-sets were linked. Logistic regression was used to investigate the factors [socio-economic position, age, sex, histology, co-morbidity, year of diagnosis, stage, and performance status] that may influence the likelihood of referral, diagnosis and treatment within target, for 28,733 lung cancer patients diagnosed in 2006-2010. Results Late-stage, poor performance status and small-cell histology were associated with a higher likelihood of post-primary care referral, diagnosis and treatment within target. Older patients were significantly less likely to receive treatment within the 31 day [odds ratio(OR)=0.79, 95% confidence interval(CI) 0.69 to 0.91] and 62 day target [OR=0.80, 95%CI 0.67 to 0.95] compared to younger patients. Conclusion Older patients waited longer for treatment and this may be unjustified. Patients who appeared ill were referred, diagnosed and treated more quickly and this ‘sicker quicker’ effect may cancel out system socio-economic inequalities that might result in longer time intervals for more deprived patients.

Publication metadata

Author(s): Forrest LF, Adams J, White M, Rubin G

Publication type: Article

Publication status: Published

Journal: British Journal of Cancer

Year: 2014

Pages: 1843-1851

Online publication date: 09/09/2014

Acceptance date: 24/07/2014

Date deposited: 01/09/2017

ISSN (print): 0007-0920

ISSN (electronic): 1532-1827

Publisher: Nature Publishing Group


DOI: 10.1038/bjc.2014.472


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Funder referenceFunder name
Cancer Research UK
Centre for Translational Research in Public Health
National Institute for Health Research
British Heart Foundation
Economic and Social Research Council
Medical Research Council