Background: Survival for people with lung cancer is poor and inequalities in access to care have been demonstrated. Methods: Primary care data from The Health Improvement Network, secondary care data from Hospital Episodes Statistics and the National Lung Cancer Audit, and death records from the Office for National Statistics, were used to investigate clinical questions in lung cancer. Matched case-control methodology was used to investigate the association between sex, smoking quantity, chronic obstructive lung disease (COPD), and lung cancer. Case control and cohort studies were performed to investigate early mortality after lung cancer surgery and treatment decisions in small cell lung cancer (SCLC). Multivariate logistic regression was used to generate a predictive score for early mortality after lung cancer surgery. Results: Sex significantly modified the effect of smoking on lung cancer with women at higher risk for the same quantity smoked. COPD was strongly associated with lung cancer in univariate analysis however this was heavily confounded by smoking and strongly related to timing of diagnosis. For people with non-small cell lung cancer, 90-day mortality after surgery was 5.9%. Age, co-morbidity index, performance status, procedure type and stage were significantly associated with this outcome and therefore make up the predictive score. 70% of people with SCLC were treated with chemotherapy however this varied according to several factors including referral method and socioeconomic status. Survival after chemotherapy for people with SCLC was similar to that reported in clinical trials. Conclusions: The work in thesis provides further evidence that women are at higher risk of lung cancer per quantity of cigarettes smoked, and challenges the commonly held belief that COPD is a strong independent risk factor for lung cancer. In addition it produced a predictive score for early mortality following lung cancer surgery, and provides information on treatment decisions and outcomes for SCLC.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:635058 |
| Date | January 2014 |
| Creators | Powell, Helen |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/14092/ |
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