Comparison of patterns of care in lung cancer in three area health services in New South Wales, Australia

Background: Lung cancer is the leading cause of cancer deaths in New South Wales (NSW). The incidence of and mortality from lung cancer differ throughout different area health services in NSW. Aim: To compare patterns of care in lung cancer among three area health services in NSW. Methods: South-western Sydney Area Health Service (SWSAHS), Northern Sydney Area Health Service (NSAHS) and Hunter Area Health Service (HAHS) -residents diagnosed with lung cancer in 1996 were identified from the NSW Central Cancer Registry and their medical records were reviewed. The main outcome measures were specialist care, investigations, treatment and survival. Results: The study population comprised 256 SWSAHS, 270 NSAHS and 212 HAHS residents. NSAHS residents were older, with a median age of 73 years compared with 68 years in SWSAHS and 70 years in HAHS (P = 0.001). The performance status and stage distributions of the populations were similar. Twenty per cent of HAHS residents did not have a pathological diagnosis compared with 10% in SWSAHS and 9% in NSAHS (P = 0.005). Forty-five per cent of HAHS residents received no treatment compared with 25 and 22% in SWSAHS and NSAHS, respectively (P < 0.001). Despite these differences, there was no significant difference in overall survival. Conclusions: Lung cancer patterns of care were significantly different among the areas. The variability of practice identified in this study needs to be addressed to ensure optimum care for all patients with lung cancer. Although there was no significant difference in survival, under-utilization of efficacious treatment is likely to have affected patients' quality of life.