Postcode the major factor for lung cancer survival

Your chances of being treated for lung cancer and of surviving vary widely depending where in Scotland you live.

A study of the differences in Scotland's 15 health board areas shows the most dramatic example yet of a postcode treatment and survival lottery.

If you live in Grampian, you are 160% more likely to get treatment for the condition - one of Scotland's biggest killers - than if you live in the Ayrshire and Arran health board area.

The Scottish Executive's own figures show there is a link between the chances of treatment and the chances of survival. Someone living in Grampian diagnosed with lung cancer is twice as likely to survive beyond five years than someone in Ayrshire and Arran.

In the figures, included in the recently published Clinical Outcome Indicators 2002, southwest Scotland does particularly badly, with Dumfries and Galloway not far off the figures for Ayrshire. Along with Grampian, the best chances of being treated and of survival are in the Highlands and Islands and the Borders.

They show that, following diagnosis, nearly half of Scots have no active treatment to try to stop the lung cancer growing. Using Greater Glasgow as the base point, they show that someone in Ayrshire is 26% less likely to be treated, while those in Grampian are 93% more likely. Argyll and Clyde health board area also does worse for treatment rates than Glasgow.

These most recent statistics, which are from 1997-98, show that only 48% of those diagnosed in Ayrshire and Arran get either surgery, radiotherapy or chemotherapy treatment. In Grampian, there is a 68% chance of getting one of the three alternatives. The Scottish average was 56.5%.

Of those diagnosed with lung cancer, survival rates beyond five years are very low, but they vary widely. Those who live in Grampian have a 9.8% survival rate, while in Ayrshire and Arran it is 5.1%. The area also has the lowest survival rate for those living beyond one year after diagnosis, at 22%, while Grampian is at 31%.

A recent paper prepared for Ayrshire and Arran health board admitted that the problem of lagging behind the rest of Scotland has persisted for a decade.

It said: "Within Ayrshire and Arran the standardised mortality ratio for lung cancer remains below the Scottish average, as it has for the last decade."

The poor performance for treatment and survival of lung cancer patients in Ayrshire has been taken up by the Tory MSP for Ayr, John Scott, whose wife died from cancer two years ago. He raises fears that the problem may be worse in the years since the most recent figures, due to the problems in recruiting cancer doctors, both locally and at the Beatson Institute in Glasgow, where Ayrshire patients also go.

"It is unacceptable that there should be this disparity across what is meant to be uniform provision," he said. "It beggars belief that this difference should exist in a small country."

He criticised the board for calling for 'a debate' on cancer care in the area: "I'm not wanting a national debate. I want results. We've had the debate, we've had the money. My constituents are still suffering."

Mike Unger, chief executive of the Roy Castle Lung Cancer Foundation, agreed that the shortage of staff is part of the problem. He said: "The biggest problem in treating patients is the shortage of thoracic surgeons. There are about 40 in the UK and we need another 50."

Ayrshire and Arran Acute Hospitals NHS Trust admits that it is short of two lung cancer specialists. Dr Bob Masterton, medical director of the trust, said: "These figures relate to 1997-98. We have done much since to improve our treatment for cancer. We have made huge investment in cancer support with (pounds) 1.24 million this year and have invested in a whole range of cancer services.

"We do have specialist vacancies that we are working hard to fill, and we are also working closely with the Beatson Oncology Centre to provide the best services for Ayrshire and Arran."

The Scottish Executive said that levels of lung cancer in Scotland are unacceptable but added that new investment is tackling the problem.

A spokeswoman said: "Incidence of lung cancer in Scotland is among the highest in Europe. The Executive is committed to providing swifter, better diagnosis, treatment and care. We have made record investment of (pounds) 60m to back up our Cancer Plan and set targets so that by 2005 the maximum wait from urgent referral to treatment for all cancers will be two months."

Copyright 2002 SMG Sunday Newspapers Ltd.
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