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Table 1 Study characteristics

From: A systematic review of geographical variation in access to chemotherapy

Author, Year Setting Data sources Participants Exposure Outcome Statistical methods
Cohort studies
Beckett ‘12 [34] England, Wales, Scotland, Northern Ireland and Jersey National Lung Cancer Audit (NLCA) data ‘09 32,068 lung cancer participants diagnosed histologically or clinically and excluding cases diagnosed at post-mortem. All cancer units included. Cancer network Odds of receipt of chemotherapy in Small Cell Lung Cancer (SCLC) within one audit year, by cancer network. Logistic regression adjusted for age, sex, performance status, stage and deprivation. IMD deprivation index.
Campbell, ‘02 [29] Grampian and Highland, Scotland Scottish Cancer Registry ’95 to‘96 and case notes from hospitals 1,314 colorectal and lung cancer participants, excluding cases diagnosed at post-mortem. All cancer units included. Whether participants were diagnosed histologically and clinically:not stated. Distance to the nearest cancer centre Odds of receipt of chemotherapy within one year of diagnosis by distance travelled. Logistic regression adjusted for age, sex, deprivation, cancer site and Dukes stage and histology (lung: SCLC, NSCLC) and ISS stage, health board of residence, and mode of presentation. Carstairs deprivation index.
Cartman, ‘02 [35] The 17 districts in Yorkshire and South Humber, England Northern and Yorkshire Cancer Registry (NYCRIS) ‘86 to ‘94 22,654 lung cancer participants diagnosed histologically or clinically and excluding cases diagnosed at post-mortem. All cancer units included. Health Authority District of residence Range, numbers and percent of eligible participants receiving chemotherapy by health authority. District variation measures presented as a range in numbers and percents.
Crawford, ‘12 [40] The 17 districts in Yorkshire and South Humber, England NYCRIS ’94 to ‘02 18,221 Colorectal cancer participants diagnosed histologically or clinically. Not stated whether cases diagnosed at post-mortem were excluded. All cancer units included. Car travel time to healthcare provider Odds of receipt of chemotherapy within 6 months of diagnosis by travel time. Logistic Regression adjusted for age, sex and tumour stage. Analysis stratified by deprivation and travel time with a test for interaction. IMD deprivation score.
Crawford, ‘09 [36] The 17 districts in Yorkshire and South Humber, England NYCRIS ’94 to ’02 34,923 Lung Cancer participants diagnosed histologically or clinically and excluding cases diagnosed at post-mortem. All cancer units included. Car travel time Odds of receipt of chemotherapy within 6 months of diagnosis by travel time. Logistic regression adjusted for age and sex. Analysis stratified by deprivation and travel time. There was no adjustment for disease stage. IMD deprivation score.
Jack, ‘03 [37] South East England Thames Cancer Registry: ’95 to ‘99 32,818 participants with lung cancer confirmed histologically or clinically and excluding cases diagnosed at post-mortem. All cancer units included. Health authority of residence Ranges and medians reflecting variation in receipt of chemotherapy by health authority. The odds of receiving chemotherapy by health authority calculated. Health authority variation presented as medians and ranges. Multi-level logistic regression (participants nested in hospitals or health authorities) adjusted for age, sex, histology, deprivation, lung cancer incidence, whether first hospital attended was a radiotherapy centre, hospital, tumour stage. Townsend deprivation score.
Jones, ‘08 [31] The 17 districts in Yorkshire and South Humber, England NYCRIS ’94 to ‘02 117,097 Lung, breast, colon, rectum, ovary and prostate cancer participants, excluding cases diagnosed at post-mortem. Whether both histologically and clinically diagnosed participants were included was not stated. Units which only rarely offered treatment were excluded. Travel time Odds of receipt of chemotherapy by travel time Conditional logistic regression, adjusted for age, sex, tumour stage (where available), “site-specific characteristics” and deprivation. No tests for interaction or trend were performed. IMD deprivation score.
Laing ‘14 [45] Scotland (Highland and Western Isles and Lothian) Information Services Division and regional cancer datasets 2005 to 2010 3,308 men with prostate cancer who received treatment for prostate cancer, therefore Death Certified Only cases not included. No sites documented as excluded. Rurality determined as Highland and Western isles resident compared with Urban (Lothian) residence. Treatment receipt compared by NHS health area. Receipt of chemotherapy as ‘first treatment’ within the study period. Student t-test, Mann–Whitney U test and two-sample Z test as appropriate. Stratified by risk group (e.g. low and intermediate compared with high-risk and metastatic). No deprivation indices.
McLeod, ‘99 [41] Scotland Hospital Discharge Data SMR01 linked to General Register Office death records. Jan ‘90 to June ‘94 15,016 colorectal cancer participants. Although not explicitly stated, it is probable that participants diagnosed histologically and clinically were included and cases diagnosed at post-mortem were excluded. Units which only rarely offered treatment were excluded. Rurality of participants’ place of residence and hospital. Odds of receipt of chemotherapy within 6 months of first admission by population density of patients’ residence (rural/urban) and by each hospital trust. Multilevel logistic regression adjusting for age, sex, marital status, deprivation, type of admission, secondary diagnoses, hospital characteristics (e.g. chemotherapy availability) and severe illness. The final model was not clearly reported. Carstairs deprivation indices.
Monkhouse, ‘13 [32] England 2010-2011 118 participants with upper GI cancer. Data from post-mortem necessarily excluded as patients recruited were from Multi-disciplinary meetings. Hospital site, defined as ‘hub’ tertiary hospital or ‘spoke’ district general hospital Time to receipt of chemotherapy from first multi-disciplinary meeting. Parametric two-tailed t-test. No deprivation indices.
NLCA*’13 [28] England, Wales, Scotland, N.Ireland and Jersey Hospital NLCA ’12 data 40,216 lung cancer participants diagnosed histologically and excluding cases diagnosed at post-mortem. All cancer units included. Audit data includes clinically diagnosed cases, but not for outcomes reported here. Cancer network and hospital trust Numbers, percentages and Odds of receipt of chemotherapy in SCLC and Stage III/IV NSCLC PS 0/1 participants by hospital trust and cancer network. Logistic regression, adjusted for age, sex, socioeconomic status, performance status and stage by cancer network or hospital trust. No deprivation indices.
Patel, ‘07 [38] South East England Thames Cancer Registry ‘94 to ‘03 67,312 participants diagnosed with lung cancer histologically or clinically and excluding cases diagnosed at post-mortem. All cancer units included. Cancer Network. Odds of receipt of chemotherapy within 6 months of first diagnosis by cancer network. Logistic regression, adjusted for sex, age, type of lung cancer, cancer stage and deprivation. Tests for heterogeneity/trend were included as appropriate across categorical variables. IMD deprivation indices.
Paterson, ‘13 [42] Southeast Scotland Southeast Scotland Cancer Network colorectal database 2003-2009 4960 colorectal cancer patients. No mention of use of cases which are death certified only. No sites recorded as being excluded on base of size. Health board of residence (in addition to individual characteristics such as deprivation) Descriptive statistics as well as odds of receipt of chemotherapy. Logistic regression, adjusted for age, sex, tumour site (colon or rectum), presence of metastatic disease at diagnosis, IMD score (Scotland) and health board.
Pitchforth, ‘02 [43] Scotland Scottish Cancer Registry ’92 to ‘96 linked to the Scottish Morbidity Record of inpatient and day cases (SMR01). 7,303 Colorectal cancer participants (histologically or clinically confirmed not specified). Cases diagnosed at post-mortem were excluded. Rurality and distance to hospital of first admission. Odds of receipt of chemotherapy within 6 months of first admission by hospital and by population density (rurality). Multi-level regression, adjusted for age, sex, comorbidity, type of admission, death within first 6 months (as a marker of severity of illness) and deprivation. Participants were nested within areas, within hospitals. Distance was treated as an effect modifier. DepCat deprivation score.
Units which only rarely offered treatment were excluded.
Rich, ‘11 [39] England England NLCA and Hospital Episode Statistic (HES) data Jan ‘04-Dec 31 ‘08 7,845 Histologically confirmed SCLC participants. Units which only rarely offered treatment were also excluded It was not stated whether cases diagnosed at post-mortem were included. Hospital trust Odds of receipt of chemotherapy by hospital healthcare boundary Multilevel logistic regression adjusted for age, sex, deprivation, performance status and stage and stratified by Charlson score of comorbidity. Townsend deprivation index.
Before and After Study
Chamberlain ‘14 [30] England and Wales IMS Health data Unknown number of individuals, data based on prescribing per head of population for England and Wales Introduction of the Cancer Drugs Fund Receipt of chemotherapy Mg per 1000 population plotted using moving averages. Negative binomial regression. No deprivation score.
Stephens and Thomson, ‘12 [33] England IMS Health, England ‘09-‘11 Participants: All prescriptions of the five most commonly prescribed Cancer Drugs Fund drugs 2011. Likely included histological and clinically confirmed cases though not stated. Death certified only cases excluded. No units were excluded from analysis due to small numbers of cases. Health authority Mean volume, per head of population of prescribed cancer drugs fund chemotherapy in one year, by health authority. Variation expressed as 90th to 10th percentile differences. Mean volumes dispensed for each drug (mg/ head population). Variation between SHAs: differences between the 10th and 90th percentile for each drug. No deprivation score.
Correlational Studies
Richards, ‘04 [6] England IMS data for 16 NICE-approved cancer drugs, England NHS IMS data for 16 NICE-approved cancer drugs. Death certified only cases were excluded. Likely included histological and clinically confirmed cases though not stated. No units were excluded from analysis due to small numbers. Cancer network Mean volume of prescribed chemotherapy by cancer network. Variation demonstrated by 90th to 10th percentile differences. Mean prescribed volume (mg) per head of population per cancer network. Networks compared using 90th: 10th ratios. No deprivation score.