In a study reported in JAMA Network Open, Shrestha et al found that receipt of recommended care and treatment outcomes were associated with geographic access to care in U.S. patients with early-stage non–small cell lung cancer (NSCLC).
Study Details
The study involved data from the Surveillance, Epidemiology, and End Results dataset on patients with NSCLC newly diagnosed between January 2007 and December 2015 and followed through December 2016. Geographic access to thoracic surgeons and radiation oncologists according to U.S. counties was quantified into quintiles (quintile 1 = least access, quintile 5 = greatest access).
Key Findings
Among 65,259 patients included in the analysis, 1,071 (1.6%) were uninsured and 7,541 (11.6%) were enrolled in Medicaid.
Higher NSCLC mortality was observed among patients with the least access (quintile 1) vs the greatest access (quintile 5) to thoracic surgeons (hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.03–1.18; P < .001 for trend) and radiation oncologists (HR = 1.11, 95% CI = 1.04–1.18; P < .001 for trend).
Patients in counties with the least access vs greatest access to thoracic surgeons were less likely to undergo surgery (odds ratio [OR] = 0.80, 95% CI = 0.69–0.93, P < .001 for trend); this association was stronger for Asian patients (OR = 0.59) vs White patients (OR = 0.85; P < .001 for interaction) and for Medicaid-insured patients (OR = 0.76) vs non–Medicaid-insured patients (OR = 0.85; P = .02 for interaction).
There was no significant association between geographic access to radiation oncologists and radiotherapy use overall; however, poorer access was significantly associated with reduced radiotherapy use in older patients (age ≥ 70 years; OR = 0.85), Hispanic patients (OR = 0.65), and uninsured patients (OR= 0.63).
The investigators concluded: “In this cohort study, geographic access to cancer care was associated with guideline-recommended treatment for early-stage NSCLC and outcomes, particularly in socially marginalized patients, underscoring the importance of ensuring appropriate geographic allocations of cancer care resources and addressing travel barriers to health care to improve NSCLC treatment, prognosis, and equity.”
Ying Liu, MD, PhD, and Min Lian, MD, PhD, of Washington University School of Medicine in St. Louis, are the corresponding authors for the JAMA Network Open article.
Disclosures: The study was supported by grants from the National Cancer Institute and National Institute on Minority Health and Health Disparities. For full disclosures of all study authors, visit jamanetwork.com.
