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

Overview

Journal J Surg Res

Specialty General Surgery

Date 2023 Mar 14

PMID 36914996

Authors

Charles D Logan

Joe Feinglass

Amy L Halverson

Dalya Durst

Kalvin Lung

Samuel Kim

Ankit Bharat

Ryan P Merkow

David J Bentrem

David D Odell

Affiliations

Soon will be listed here.

Abstract

Introduction: Access to cancer care, especially surgery, is limited in rural areas. However, the specific reasons rural patient populations do not receive surgery for non-small cell lung cancer (NSCLC) is unknown. We investigated geographic disparities in reasons for failure to receive guideline-indicated surgical treatment for patients with potentially resectable NSCLC.

Methods: The National Cancer Database was used to identify patients with clinical stage I-IIIA (N0-N1) NSCLC between 2004 and 2018. Patients from rural areas were compared to urban areas, and the reason for nonreceipt of surgery was evaluated. Adjusted odds of (1) primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery were determined.

Results: The study included 324,785 patients with NSCLC with 42,361 (13.0%) from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery (P < 0.001). Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]: 1.05-1.23), (2) surgery being deemed contraindicated due to risk (aOR: 1.19, 95% CI: 1.07-1.33), (3) surgery being recommended but not performed (aOR: 1.13, 95% CI: 1.01-1.26), and (4) overall failure to receive surgery (aOR: 1.21, 95% CI: 1.13-1.29; all P < 0.001).

Conclusions: There are geographic disparities in the management of NSCLC. Rural patient populations are more likely to fail to undergo surgery for potentially resectable disease for every reason examined.

Citing Articles

Rurality predisposes departure from gold-standard care, leading to delayed or accelerated access to surgery: insights from a scoping review.

Ebrahim A, Sinha S, Adedipe I, Ahmad A, Amyotte M, Yang L Can J Surg. 2025; 68(1):E17-E31.

PMID: 39753325 PMC: 11684926. DOI: 10.1503/cjs.000124.

Disparity of the Treatment of Unresectable Non-small Cell Lung Cancer Regarding Chemotherapy: A Systematic Review and Meta-Analysis.

Ohta R, Sano C Cureus. 2024; 16(5):e60635.

PMID: 38899245 PMC: 11185987. DOI: 10.7759/cureus.60635.

Evaluation of Nationwide Trends in Nodal Sampling Guideline Adherence for Gastric Cancer: 2005-2017.

Mahenthiran A, Logan C, Janczewski L, Valukas C, Warwar S, Silver C J Surg Res. 2023; 291:514-526.

PMID: 37540969 PMC: 10529819. DOI: 10.1016/j.jss.2023.07.011.

References

Cykert S, Phifer N . Surgical decisions for early stage, non-small cell lung cancer: which racially sensitive perceptions of cancer are likely to explain racial variation in surgery?. Med Decis Making. 2003; 23(2):167-76. DOI: 10.1177/0272989X03251244. View

Veenstra J, Khalid T, Stewart K, Valji A, Bedard E, Johnson S . Automatic Referral for Potential Thoracic Malignant Diseases Detected on Computed Tomographic Scan. Ann Thorac Surg. 2020; 110(6):1869-1873. DOI: 10.1016/j.athoracsur.2020.05.040. View

Johnson A, Hines R, Johnson 3rd J, Bayakly A . Treatment and survival disparities in lung cancer: the effect of social environment and place of residence. Lung Cancer. 2014; 83(3):401-7. DOI: 10.1016/j.lungcan.2014.01.008. View

Hua X, Ward K, Gillespie T, Lipscomb J, Goodman M . Non-small cell lung cancer treatment receipt and survival among African-Americans and whites in a rural area. J Community Health. 2013; 39(4):696-705. DOI: 10.1007/s10900-013-9813-7. View

Chadha A, Ganti A, Sohi J, Sahmoun A, Mehdi S . Survival in untreated early stage non-small cell lung cancer. Anticancer Res. 2005; 25(5):3517-20. View

Evans 3rd N, Grenda T, Alvarez N, Okusanya O . Narrative review of socioeconomic and racial disparities in the treatment of early stage lung cancer. J Thorac Dis. 2021; 13(6):3758-3763. PMC: 8264710. DOI: 10.21037/jtd-20-3181. View

Nicoli C, Sprague B, Anker C, Lester-Coll N . Association of Rurality With Survival and Guidelines-Concordant Management in Early-stage Non-Small Cell Lung Cancer. Am J Clin Oncol. 2019; 42(7):607-614. DOI: 10.1097/COC.0000000000000549. View

Delman A, Ammann A, Turner K, Vaysburg D, Van Haren R . A narrative review of socioeconomic disparities in the treatment of esophageal cancer. J Thorac Dis. 2021; 13(6):3801-3808. PMC: 8264668. DOI: 10.21037/jtd-20-3095. View

Dalton A, Bunton A, Cykert S, Corbie-Smith G, Dilworth-Anderson P, McGuire F . Patient characteristics associated with favorable perceptions of patient-provider communication in early-stage lung cancer treatment. J Health Commun. 2013; 19(5):532-44. DOI: 10.1080/10810730.2013.821550. View

10.

Blake K, Moss J, Gaysynsky A, Srinivasan S, Croyle R . Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends. Cancer Epidemiol Biomarkers Prev. 2017; 26(7):992-997. PMC: 5500425. DOI: 10.1158/1055-9965.EPI-17-0092. View

11.

Farjah F, Wood D, Yanez 3rd N, Vaughan T, Symons R, Krishnadasan B . Racial disparities among patients with lung cancer who were recommended operative therapy. Arch Surg. 2009; 144(1):14-8. PMC: 2688646. DOI: 10.1001/archsurg.2008.519. View

12.

Ray M, Faris N, Derrick A, Smeltzer M, Osarogiagbon R . Rurality, Stage-Stratified Use of Treatment Modalities, and Survival of Non-small Cell Lung Cancer. Chest. 2020; 158(2):787-796. PMC: 7417381. DOI: 10.1016/j.chest.2020.04.042. View

13.

Shugarman L, Mack K, Sorbero M, Tian H, Jain A, Scott Ashwood J . Race and sex differences in the receipt of timely and appropriate lung cancer treatment. Med Care. 2009; 47(7):774-81. DOI: 10.1097/MLR.0b013e3181a393fe. View

14.

Tohme S, Kaltenmeier C, Bou-Samra P, Varley P, Tsung A . Race and Health Disparities in Patient Refusal of Surgery for Early-Stage Pancreatic Cancer: An NCDB Cohort Study. Ann Surg Oncol. 2018; 25(12):3427-3435. DOI: 10.1245/s10434-018-6680-6. View

15.

Castro S, Sosa E, Lozano V, Akhtar A, Love K, Duffels J . The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: a narrative review of socioeconomic disparities in lung cancer screening. J Thorac Dis. 2021; 13(6):3745-3757. PMC: 8264678. DOI: 10.21037/jtd-20-3281. View

16.

Wagner E, Ludman E, Aiello Bowles E, Penfold R, Reid R, Rutter C . Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2013; 32(1):12-8. PMC: 3867643. DOI: 10.1200/JCO.2013.51.7359. View

17.

Bach P, Cramer L, Warren J, Begg C . Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999; 341(16):1198-205. DOI: 10.1056/NEJM199910143411606. View

18.

Mehta R, Lenzner D, Argiris A . Race and health disparities in patient refusal of surgery for early-stage non-small cell lung cancer: a SEER cohort study. Ann Surg Oncol. 2011; 19(3):722-7. DOI: 10.1245/s10434-011-2087-3. View

19.

Lathan C, Neville B, Earle C . The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol. 2005; 24(3):413-8. DOI: 10.1200/JCO.2005.02.1758. View

20.

Herb J, Dunham L, Mody G, Long J, Stitzenberg K . Lung Cancer Surgical Regionalization Disproportionately Worsens Travel Distance for Rural Patients. J Rural Health. 2020; 36(4):496-505. DOI: 10.1111/jrh.12440. View