Overview of Lung Cancer Surgery in Ontario

• Published in: The Annals of thoracic surgery Vol. 91; no. 2; pp. 361 - 366
• Main Authors: Bendzsak, Anna, MD, MHSc, Nenshi, Rahima, MD, MS, Darling, Gail, MD, Schultz, Susan E., MS, Gunraj, Nadia, MPH, Wilton, Andrew S., MS, Simunovic, Marko, MD, MPH, Jacob, Binu, MS, Urbach, David R., MD, MS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2011; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchoscopy - utilization; Cardiology. Vascular system; Cardiothoracic Surgery; Female; General Surgery - methods; General Surgery - statistics & numerical data; Hospitals - classification; Humans; Incidence; Lung Neoplasms - epidemiology; Lung Neoplasms - surgery; Male; Mediastinoscopy - utilization; Medical sciences; Middle Aged; Ontario - epidemiology; Palliative Care - methods; Pleurodesis - utilization; Pneumology; Pneumonectomy - utilization; Registries; Resource Allocation - methods; Socioeconomic Factors; Surgery; Thoracic Surgery - methods; Thoracic Surgery - statistics & numerical data; Thoracoscopy - utilization; Thoracostomy - utilization; Tumors of the respiratory system and mediastinum; Young Adult; Canada; North America; Ontario; America; 4; 10; Lung disease; Treatment; Respiratory disease; Lung cancer; Surgery; Bronchus disease; Anesthesia; Malignant tumor; Circulatory system; Review; Cardiology; Cancer
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.09.056

Background Surgery is the primary curative treatment for lung cancer and thus appropriate surgical resource allocation is critical. This study describes the distribution of lung cancer incidence and surgical care in Ontario, a Canadian province with universal health care, for the fiscal year of 2004. Methods All new lung cancer cases in Ontario between April 1, 2003 and March 31, 2004 were identified in the Ontario Cancer Registry. Incidence rates and surgical procedures were compared by age, health region, neighborhood income, and community size. Results Lung cancer incidence was highest in lower income neighborhoods (90.2 cases of 100,000 vs 55.6 in the highest quintile, p < 0.001) and smaller communities (87.1 of 100,000 in communities less than 100,000 vs 56.3 of 100,000 in cities greater than 1.25 million, p < 0.001). Surgical interventions were most common in younger patients (47.4% aged 20 to 54 years versus 30.5% greater than 75 years, p < 0.001), and those in wealthier neighborhoods (43.4% in highest quintile versus 35.8% in the lowest, p < 0.001). Surgical procedures overall and specifically formal resections (20% in cities >1.25 million versus 18% in communities <100,000, p < 0.03) were more common in larger communities (43.4% versus 37.7%, p < 0.001). Pneumonectomy was more common in smaller communities (14.5% vs 9.9%, p = 0.048, whereas more lobar (53.8 vs 45.2%, p = 0.01) and sublobar resections (44.9% vs 31.7%, p < 0.0001) were more common in larger communities. Thoracic surgeons provided the majority of formal resections (51% to 57%) compared with general surgeons (17% to 21%). Conclusions Lung cancer incidence and surgical care vary significantly by health region, income level, and community size. These disparities require further evaluation to meet the needs of patients with lung cancer.