Regional Variation in Treatment for Highest-Risk Patients With Non-Small Cell Lung Cancer
| Autor: | Albert J. Farias, Scott M. Atay, Anthony W. Kim, Katherine J. Bick, Peggy J. Ebner, Li Ding, Sean C. Wightman, P. Michael McFadden, Elizabeth A. David |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
Lung Neoplasms business.industry Standard treatment Hazard ratio Cancer Odds ratio medicine.disease Logistic regression Survival Analysis United States Odds Socioeconomic Factors Carcinoma Non-Small-Cell Lung medicine Humans Surgery Cardiology and Cardiovascular Medicine Lung cancer business Survival analysis Proportional Hazards Models Demography |
| Zdroj: | The Annals of Thoracic Surgery. 113:1282-1290 |
| ISSN: | 0003-4975 |
| Popis: | BACKGROUND Non-small cell lung cancer patients with multiple high-risk socioeconomic factors experience treatment and survival disparities. We aim to assess whether disparities in treatment and survival vary by region for patients with 3 or more high-risk socioeconomic factors. METHODS The National Cancer Database was queried for patients with clinical stage I-IIA non-small cell lung cancer diagnosed between 2010 and 2015. Patients were categorized into 3 groups: standard treatment, nonstandard treatment, and no curative treatment. Multivariable logistic regression was used to evaluate regional differences in treatment. Cox proportional hazards regression and the Kaplan-Meier method were used for survival analysis. All statistical tests were 2-sided. RESULTS A total of 93,211 patients met inclusion criteria. For patients with 3 or more high-risk socioeconomic factors, the odds of nonstandard treatment were significantly greater in 6 regions compared with New England, greatest in West North Central (odds ratio 2.09, P < .001). The odds of no curative treatment were significantly greater in 7 regions compared with New England, greatest in West South Central (odds ratio 3.56, P < .001). West North Central was associated with the highest risk of all-cause mortality compared with New England (hazard ratio 1.10, P < .001), and Middle Atlantic was associated with the lowest (hazard ratio 0.86, P < .001). The 5-year overall survival was longest in Middle Atlantic (60.8%) and shortest in Mountain (36.8%). CONCLUSIONS Patients with 3 or more high-risk socioeconomic factors experience treatment and survival disparities across the United States, though disparities are more pronounced in certain regions. Regional interventions may help mitigate disparities among highest risk non-small cell lung cancer patients. |
| Databáze: | OpenAIRE |
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