Disparities in Guideline-Concordant Treatment for Pathologic N1 Non-Small Cell Lung Cancer.

Published on May 1, 2020in The Annals of Thoracic Surgery4.33
路 DOI :10.1016/J.ATHORACSUR.2019.11.059
Omar Toubat5
Estimated H-index: 5
,
Scott M. Atay15
Estimated H-index: 15
+ 5 AuthorsElizabeth A. David15
Estimated H-index: 15
Sources
Abstract
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.
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#2Li Ding (SC: University of Southern California)H-Index: 8
Last. Elizabeth A. David (SC: University of Southern California)H-Index: 15
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Abstract Background Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based upon patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC. Methods The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into 3 treatment groups: primary resection (SUR), nonstandard treatments (che...
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Last. Br铆d M. RyanH-Index: 21
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Abstract Introduction Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type. Methods Using population-based cancer registry data鈥擲u...
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#2Alison J. CancholaH-Index: 29
Last. Scarlett Lin GomezH-Index: 58
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PurposeRacial/ethnic disparities in cancer survival in the United States are well documented, but the underlying causes are not well understood. We quantified the contribution of tumor, treatment, hospital, sociodemographic, and neighborhood factors to racial/ethnic survival disparities in California.Materials and MethodsCalifornia Cancer Registry data were used to estimate population-based cancer-specific survival for patients diagnosed with breast, prostate, colorectal, or lung cancer between ...
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Abstract This selection from the NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC) focuses on targeted therapies and immunotherapies for metastatic NSCLC, because therapeutic recommendations are rapidly changing for metastatic disease. For example, new recommendations were added for atezolizumab, ceritinib, osimertinib, and pembrolizumab for the 2017 updates.
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Rationale: There is increased lung cancer mortality in rural areas of the United States. However, it remains unclear to what extent rural鈥搖rban differences in disease incidence, stage at diagnosis, or treatment explain this finding.Objectives: To explore the relationship between smoking rates, lung cancer incidence, and lung cancer mortality in populations across the rural鈥搖rban continuum and to determine whether survival is decreased in rural patients diagnosed with lung cancer and whether this...
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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistic...
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Abstract Background For patients with non鈥搒mall cell lung cancer (NSCLC) metastatic to聽hilar lymph nodes (N1), guidelines recommend surgery and adjuvant chemotherapy in operable patients and chemoradiation (CRT) for those deemed inoperable. It is unclear how these recommendations are applied nationally, however. Methods The National Cancer Database was queried to identify patients with a tumor 45聽Gy) or surgical resection were considered adequately treated. Remaining patients were classified as ...
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Abstract Objective The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC). Methods and materials This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employ...
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Last. Sudish C. Murthy (Cleveland Clinic)H-Index: 52
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Background The treatment of stage I and II non-small cell lung cancer (NSCLC) in patients with good or low surgical risk is primarily surgical resection. However, this area is undergoing many changes. With a greater prevalence of CT imaging, many lung cancers are being found that are small or constitute primarily ground-glass opacities. Treatment such as sublobar resection and nonsurgical approaches such as stereotactic body radiotherapy (SBRT) are being explored. With the advent of minimally in...
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Background The National Cancer Data Base (NCDB) is a large, geographically diverse hospital-based cancer registry that has been used to study factors related to cancer diagnosis, treatment, and survival. The primary purpose of this study was to compare the case counts and characteristics of patients in NCDB with population-based registries reported in the United States Cancer Statistics (USCS).
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Cited By4
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#1Paige Neroda (Clemson University)
#6Jiande Wu (LSU Health Sciences Center New Orleans)H-Index: 6
Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I-IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. ...
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#1Keith D. Mortman (George Washington University Hospital)H-Index: 3
Last. Michael A. NapolitanoH-Index: 2
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OBJECTIVES Low-dose computed tomography (LDCT) screening is an important tool for reducing lung cancer mortality. This study describes a single center's experience with LDCT and attempts to identify any barriers to compliance with standard guidelines. MATERIALS AND METHODS This is a retrospective review of a single university-based hospital system from 2015 to 2019. All individuals who met eligibility for lung cancer screening were entered into a database. The definition of adherence with the sc...
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