Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Social disparities in lung cancer surgery utilisation and prognosis: a statewide, data-linkage study (126740)

Jianrong Zhang 1 , Luc te Marvelde 1 , Sue Evans 1 2 , Gavin Wright 3 4 , Tommy Hong Ting Wong 1
  1. Cancer Council Victoria, Melbourne, VIC, Australia
  2. Monash University, Melbourne, Victoria, Australia
  3. University of Melbourne, Melbourne, VIC, Australia
  4. St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia

Objectives/purpose: To evaluate the differences in surgery utilisation and prognosis by demographic factors among lung cancer patients.

Sample and setting: Adult patients receiving active treatment following diagnosis with incident primary lung cancer in 2011-2022. Active treatment includes thoracic surgery, chemotherapy or radiotherapy within one year of diagnosis, as identified in the linkage between Victorian Cancer Registry and Victorian Admitted Episodes Dataset (VAED), Victorian Radiotherapy Minimum Data Set (VRMDS).

Results: Among the 25,139 patients identified as receiving active treatment, 31% treated by surgery. After adjusting for age, sex, year of diagnosis and comorbidity counts, patients in higher socio-economic indexes for areas (SEIFA) quintiles were more likely to undergo surgery (adjusted odds ratio (OR) for 2nd quintile 1.11 [95% CI, 1.03, 1.20]; 3rd quintile 1.15 [1.06, 1.24]; 4th quintile 1.26 [1.16, 1.37]; 5th quintile 1.55 [1.42, 1.69]) than those in the lowest quintile. Compared with patients born in Australia or New Zealand, patients born in East Asia (adjusted OR 1.41 [95% CI 1.25-1.59]), Europe (1.11 [1.03, 1.20]), Southern & Central Asia (1.37 [1.05-1.77]) and Sub-Saharan Africa (1.36 [1.01, 1.82]) were more likely to undergo surgery. Compared with patients living in the North Eastern Melbourne Integrated Cancer Services (ICS), patients living in the Western & Central Melbourne ICS (adjusted OR 0.88 [0.81, 0.96]), Hume Regional ICS (0.86 [0.76, 0.98]), Barwon South Western ICS (0.76 [0.67, 0.85]), Loddon Mallee ICS (0.74 [0.66, 0.83]), Gippsland Regional ICS (0.70 [0.62, 0.79]), and Grampians ICS (0.66 [0.57, 0.76]) were less likely to undergo surgery. Multivariable analyses indicate that patients in the lowest SEIFA quintile, born in East Asia, and living in Barwon Southern Western, Loddon Mallee, Gippsland and Grampians ICS had poorer overall survival.

Conclusion and clinical implications: Social disparities are observed in surgery utilisation among lung cancer patients in Victoria, which was reflected in survival differences.