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Rural-Urban Disparities in Receipt of Surgery for Potentially Resectable Non-Small Cell Lung Cancer.

Charles D Logan1, Joe Feinglass2, Amy L Halverson3

  • 1Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611.

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Summary

Rural patients with non-small cell lung cancer (NSCLC) are less likely to receive surgery. This study found geographic disparities, with rural populations experiencing higher rates of failure to undergo recommended surgical treatment for NSCLC.

Keywords:
AdultDatabaseLung cancer surgeryNon–small cell lung cancerRural disparitiesSurgical outcomesThoracic surgery

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Area of Science:

  • Oncology
  • Health Services Research
  • Rural Health

Background:

  • Access to timely cancer care, particularly surgery, is a significant challenge in rural regions.
  • Specific barriers preventing rural patients from receiving guideline-indicated surgery for non-small cell lung cancer (NSCLC) remain under-investigated.

Purpose of the Study:

  • To investigate geographic disparities in the reasons for failure to receive guideline-indicated surgical treatment among patients with potentially resectable non-small cell lung cancer (NSCLC).

Main Methods:

  • Utilized the National Cancer Database (2004-2018) to identify patients with clinical stage I-IIIA (N0-N1) NSCLC.
  • Compared surgical treatment rates and reasons for nonreceipt between rural and urban patient populations.
  • Determined adjusted odds for primary nonsurgical management, surgical contraindication due to risk, recommended but not performed surgery, and overall failure to receive surgery.

Main Results:

  • The study included 324,785 NSCLC patients, with 13.0% from rural areas.
  • Overall, 58.8% of rural patients underwent surgery compared to 62.4% of urban patients (P < 0.001).
  • Rural patients demonstrated increased odds for primary nonsurgical management (aOR: 1.14), surgery deemed contraindicated (aOR: 1.19), surgery recommended but not performed (aOR: 1.13), and overall failure to receive surgery (aOR: 1.21).

Conclusions:

  • Significant geographic disparities exist in the management of non-small cell lung cancer (NSCLC).
  • Rural patient populations face higher likelihoods of failing to receive recommended surgical intervention for potentially resectable NSCLC across all examined reasons.