Disparities in Guideline-Concordant Treatment for Pathologic N1 Non-Small Cell Lung Cancer.
Published on May 1, 2020in The Annals of Thoracic Surgery4.33
· DOI :10.1016/J.ATHORACSUR.2019.11.059
Abstract Background Socioeconomic status (SES) disparities in the surgical management of patients with non-small cell lung cancer (NSCLC) are well-described. Disparities in the receipt of adjuvant chemotherapy are poorly understood. We assessed the influence of SES on adjuvant chemotherapy following resection in patients with pN1 NSCLC. Methods The National Cancer Database was queried for cN0/N1 NSCLC patients who underwent surgical resection and had demonstrated pN1 disease. This cohort was further divided into those who received multi-agent adjuvant chemotherapy (MAAC) versus surgery only treatment. Factors associated with treatment assignment were examined and long-term survival was compared. Results Of the 14,892 patients who underwent resection for pN1 disease, 8,061 (54.1%) received MAAC. Patients were less likely to receive MAAC if they resided in rural areas (OR 1.23, 95% CI 1.11-1.37, p Conclusions pN1 NSCLC patients living in rural areas or who are uninsured or on Medicaid insurance are at increased risk of not receiving MAAC. Treatment with MAAC significantly improves long-term survival of pN1 patients. Efforts should be made to ensure these at-risk groups receive guideline-concordant care.