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Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer
Abigail J Fong1, Heidi Reich2, James Mirocha1
1Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Background:
The National Comprehensive Cancer Network recommends surgical resection for stage I small cell lung cancer (SCLC). Despite these recommendations and the curative potential of such surgery, many continue to underutilize surgery. Our aim is to investigate factors that contribute to underutilization of surgery for stage I SCLC.
Methods:
The National Cancer Database was queried to identify patients with SCLC stage I-IV from 2004 to 2018. Staging was defined by the American Joint Committee on Cancer guidelines. Cochran-Armitage analysis was performed to analyze trends in surgical treatment for patients diagnosed with stage I SCLC. Multivariable logistic regression assessed relationships between patient factors and surgical treatment.
Results:
A total of 296,583 patients were diagnosed with SCLC. Of the stage I patients (n = 13,003), only 29.4.% (n = 3823) underwent surgery. Trend analysis demonstrated increased frequency of surgical treatment for stage I SCLC over years 2004 to 2017, from 14.9% to 39.6% (P < .0001). Factors that were associated with underutilization of surgery for stage I SCLC include African American race, lower median income, nonprivate insurance or Medicare, community facility, and geographic regions other than the Northeast.
Conclusions:
Surgical treatment for stage I SCLC remains underutilized and our study identifies notable associated factors. The recognition of these factors may help patients overcome barriers to receiving recommended treatments, improve guideline adherence, and overall quality of care for stage I SCLC patients.
Insights
Surgical treatment for early-stage small cell lung cancer (SCLC) is underutilized. Factors like race, income, insurance, and location influence access to this recommended care.
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.
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