Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Health Services Research

Background:

• National Comprehensive Cancer Network guidelines recommend surgical resection for stage I small cell lung cancer (SCLC).
• Despite curative potential, surgery for stage I SCLC is frequently underutilized.
• Factors contributing to this underutilization require investigation to improve patient care.

Purpose of the Study:

• To investigate factors associated with the underutilization of surgical resection in patients diagnosed with stage I small cell lung cancer (SCLC).
• To identify patient and facility-level characteristics that correlate with decreased surgical treatment rates.

Main Methods:

• Analysis of the National Cancer Database (2004-2018) for patients with SCLC (stages I-IV).
• Application of Cochran-Armitage analysis for trend assessment in surgical treatment of stage I SCLC.
• Multivariable logistic regression to evaluate patient-specific factors linked to surgical treatment decisions.

Main Results:

• Out of 13,003 stage I SCLC patients, only 29.4% received surgical treatment.
• A significant increasing trend in surgical treatment for stage I SCLC was observed from 2004 (14.9%) to 2017 (39.6%).
• Underutilization was associated with African American race, lower income, non-private/Medicare insurance, community facilities, and non-Northeastern geographic regions.

Conclusions:

• Surgical treatment for stage I SCLC remains underutilized, with specific demographic and socioeconomic factors identified as significant correlates.
• Recognizing these barriers is crucial for enhancing guideline adherence and improving the quality of care for stage I SCLC patients.
• Interventions addressing identified disparities may help overcome obstacles to recommended surgical interventions.