Deprivation, distance and death in lung cancer

There are wide differences in survival rates for lung cancer both within the UK1 and when comparing the UK with many countries in the western world.2 Socio-economic inequalities have been shown to have a significant impact on survival for the large majority of cancers in adults in the UK,3 and many studies have reported lower lung cancer survival rates in patients of lower socio-economic status.4––7 There is also wide variation in treatment rates of patients with lung cancer by geographical region,1 ,8 ,9 and the paper by Forrest et al 10 in this issue adds to the broadly consistent finding of lower treatment rates in patients from lower socio-economic backgrounds.11 In addition, many patients with lung cancer die very soon after diagnosis, a significant proportion with a particularly poor prognosis first presenting to secondary care as an emergency admission,12 a route to diagnosis that is more common in patients of lower socio-economic status.13 This would imply opportunities for earlier recognition of patients at high risk of lung cancer in primary care. Four important studies appear in this issue of Thorax , three from the UK and one from Australia, that address the issues of earlier diagnosis, early death, undertreatment and geographical distance from specialist centres, all of which have significant implications for optimising service provision for patients with lung cancer.10 ,14–16 Despite major improvements to cancer care in England over the last 15 years, the ‘deprivation gap’, in other words, the survival difference between individuals from the least-deprived compared with the most-deprived groups, has not improved significantly in recent years,17 a finding confirmed and startlingly quantified in a recent report from Public Health England's National Cancer Intelligence Network.18 This analysis estimated that both …