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Resection rate for patients with tissue confirmation of NSCLC (2004-2008:England)

Resection rate for patients with tissue confirmation of NSCLC (2004-2008:England). *adjusted for sex, age, PS, stage, deprivation index and Charlson co-morbidity index. Resection rate by PCT 2004-6*. *Source: National Cancer Data Repository. Mortality Hazard Ratios for Lung Cancer

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Resection rate for patients with tissue confirmation of NSCLC (2004-2008:England)

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  1. Resection rate for patients with tissue confirmation of NSCLC (2004-2008:England) *adjusted for sex, age, PS, stage, deprivation index and Charlson co-morbidity index

  2. Resection rate by PCT 2004-6* *Source: National Cancer Data Repository

  3. Mortality Hazard Ratios for Lung Cancer Patients in England 2004-6 related to resection rate by government office region N = 77,349

  4. Mortality hazard ratios for resected patients; England 2004-6 by Government Regional Office N = 6,900

  5. Mortality hazard ratios for resected patients; England 2004-6 by Government Regional Office Implications: comparing the top quintile PCT with Lower 4: 5420 deaths ‘postponed’ by surgery 146 deaths related to higher resection rates N = 6,900

  6. The effects of investing in thoracic surgery on lung cancer resection rates Kelvin LauDavid WallerSridhar RathinamMichael PeakeGlenfield Hospital, Leicester, UK UK National Lung Cancer Audit Programme

  7. Lung cancer in UK is under treated

  8. There is a wide variation in lung cancer surgery in England 5.2% – 10.1% 10.9% – 13.2% 13.6% – 14.5% 14.6% – 16.5% 16.9% – 31.8%

  9. Hypothesis the variability in Resection Rate is determined by the provision of specialist thoracic surgery Method We correlated results of the NATIONAL LUNG CANCER AUDIT with manpower data for cardiothoracic surgery

  10. National Lung Cancer Audit results • 33 English Cancer Networks, comprising 174 Hospital Trusts • 31 Trusts had Thoracic Surgery in house (Base Hospitals) • 18 (58%) Trusts had less than 2 Pure Thoracic Surgeons • 13 (42%) Trusts had 2 or more Pure Thoracic Surgeons • In 2008, 15,774 cases of histologically confirmed NSCLC • 18.4% cStage I and II • 14.2% underwent resection

  11. Resection rates are higher in centres who treat more cases R = 0.155 p = 0.06

  12. Resection rates are higher in base than in referring centres Across the UK Within each Cancer Network p < 0.001 p < 0.001 Resection Rate

  13. Resection rates are higher in centres with 2 or more specialist thoracic surgeons p = 0.02 Resection Rate

  14. Resection rates are higher when surgeons attend preoperative MDTs p = 0.012

  15. The increase in resection rate was greatest in those units who employed new thoracic surgeons p = 0.04 19% 66% 2009 Growth Resection Rate 2008

  16. Conclusion • Lung cancer resection rates in UK can be increased by • Increasing the number of specialist thoracic surgeons at preoperative MDTs in referring hospitals • Increasing the number of specialist thoracic surgeons in operating centres • Thereby increasing the individual caseload in any unit • Individual Units must invest in more pure Thoracic Surgical appointments • The number of specialist thoracic surgeons in training must be increased

  17. Resection Rate- Leicester * A Martin-Ucar et al. Lung Cancer. 2004; 46:227-232 (specialist thoracic surgeon appointed 1997)

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