Disparities in Guideline-Concordant Treatment for Pathologic N1 Non-Small Cell Lung Cancer

Toubat, Omar; Atay, Scott M.; Kim, Anthony W.; Ding, Li; Farias, Albert J.; Ebner, Peggy J.; McFadden, P. Michael; David, Elizabeth A.

doi:10.1016/j.athoracsur.2019.11.059

Cited by 27 publications

(26 citation statements)

References 25 publications

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“…We examined the impact from several social determinants on timely surgery and whether the examined social determinants could explain the observed racial disparity. Unsurprisingly, private insurance was a significant predictor of the receipt of timely surgery or guideline-concordant care in lung cancer patients (17). Medicaid insured patients tended to experience the largest delay in receiving treatment (17).…”

Section: Discussionmentioning

confidence: 96%

“…Unsurprisingly, private insurance was a significant predictor of the receipt of timely surgery or guideline-concordant care in lung cancer patients (17). Medicaid insured patients tended to experience the largest delay in receiving treatment (17). In a national study, compared to NSCLC patients with private insurance, the diagnosis-to-surgery interval was 2.3 days longer for Medicare patients, 10.8 days longer for Medicaid patients, and 7.8 days for longer for patients who were uninsured or whose insurance status was unknown (9).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that cancer survivors in Medicaid expansion states were more likely to be insured, to have access to care, and to be diagnosed at an early stage of disease than those in non-expansion states (17,24). Louisiana was one of the states with earliest initiation of ACA expansion in the country (23).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have found that social and economic factors influence disparities in lung cancer incidence and survival, even more than biological differences. Several social determinants, including income, insurance status, marital status, and rural residence, are associated with the receipt of standard care for NSCLC (17). This study had three objectives: (1) to investigate whether there is a racial disparity in receipt of timely surgery among stage I-IIIA NSCLC patients; (2) if the racial disparity exists, to examine whether the disparity can be explained by multiple social determinants; and 3) to explore whether the social determinants have a differential effect on timely surgery in each racial group.…”

Section: Introductionmentioning

confidence: 99%

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Racial Disparity and Social Determinants in Receiving Timely Surgery Among Stage I–IIIA Non-small Cell Lung Cancer Patients in a U.S. Southern State

Neroda

Hsieh

et al. 2021

Front. Public Health

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Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I–IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. Diagnosis-to-surgery interval >6 weeks were considered as delayed surgery. Social determinants included marital status, insurance, census tract level poverty, and census tract level urbanicity. Multivariable logistic regression and generalized multiple mediation analysis were conducted. A total of 3,616 white (78.9%) and black (21.1%) patients were identified. The median time interval from diagnosis to surgery was 27 days in whites and 42 days in blacks (P < 0.0001). About 28.7% of white and 48.4% of black patients received delayed surgery (P < 0.0001). Black patients had almost two-fold odds of receiving delayed surgery than white patients (adjusted odds ratio: 1.91; 95% confidence interval: 1.59–2.30). Social determinants explained about 26% of the racial disparity in receiving delayed surgery. Having social support, private insurance, and living in census tracts with lower poverty level were associated with improved access to timely surgery. The census tract level poverty level a stronger effect on delayed surgery in black patients than in white patients. Tailored interventions to improve the timely treatment in NSCLC patients, especially black patients, are needed in the future.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial Disparity and Social Determinants in Receiving Timely Surgery Among Stage I–IIIA Non-small Cell Lung Cancer Patients in a U.S. Southern State

Neroda

Hsieh

et al. 2021

Front. Public Health

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“…In addition, several studies have described disparities in the use of LDCT screening in underserved populations, including racial/ethnic minorities (11,12), those living in rural areas with more limited access to care (13), and other vulnerable populations (14,15). Efforts to understand disparities in LDCT screening and their contributing factors have become increasingly relevant, as previous studies have shown that these same underserved populations have a greater incidence of lung cancer and are less likely to receive appropriate treatment (16)(17)(18)(19). Therefore, the objective of the present narrative review is to discuss lung cancer screening disparities in underserved populations and to examine methods of improving access to lung cancer screening in these patients.…”

Section: Review Articlementioning

confidence: 99%

A narrative review of lung cancer screening in underserved populations

Toubat¹,

David²

2021

Curr Chall Thorac Surg

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Lung cancer screening with low-dose computed tomography (LDCT) is an effective approach for the early detection of lung cancer and the reduction of lung cancer specific mortality in high risk individuals. Despite recommendations for LDCT screening by the National Comprehensive Cancer Network (NCCN) and the United States Preventive Services Task Force, the utilization of LDCT screening in clinical practice has been low. Moreover, significant disparities in the use of LDCT have been described in underserved populations, including African American or black patients, rural patients with limited access to LDCT screening facilities, and other vulnerable patient groups with known risk factors for developing lung cancer. Several patient, provider, and healthcare systems level approaches have been proposed to mitigate lung cancer screening disparities. Such approaches include raising awareness of LDCT screening benefits and the evidence in support of LDCT screening among healthcare providers, educating patients on LDCT screening and optimizing shared decision-making approaches between patients and providers, and expanding patient access to LDCT screening through free and mobile lung cancer screening programs. As lung cancer screening utilization continues to expand in clinical practice, it will be critical to continue investigating the trends, causes, and outcomes of LDCT screening disparities in underserved populations.

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Availability of cancer care services and the organization of care delivery at critical access hospitals

et al. 2023

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IntroductionCritical access hospitals (CAHs) provide an opportunity to meet the needs of individuals with cancer in rural areas. Two common innovative care delivery methods include the use of traveling oncologists and teleoncology. It is important to understand the availability and organization of cancer care services in CAHs due to the growing population with cancer and expected declines in oncology workforce in rural areas.MethodsStratified random sampling was used to generate a sample of 50 CAHs from each of the four U.S. Census Bureau‐designated regions resulting in a total sample of 200 facilities. Analyses were conducted from 135 CAH respondents to understand the availability of cancer care services and organization of cancer care across CAHs.ResultsAlmost all CAHs (95%) provided at least one cancer screening or diagnostic service. Forty‐six percent of CAHs reported providing at least one component of cancer treatment (chemotherapy, radiation, or surgery) at their facility. CAHs that offered cancer treatment reported a wide range of health care staff involvement, including 34% of respondents reporting involvement of a local oncologist, 38% reporting involvement of a visiting oncologist, and 28% reporting involvement of a non‐local oncologist using telemedicine.ConclusionGrowing disparities within rural areas emphasize the importance of ensuring access to timely screening and guideline‐recommended treatment for cancer in rural communities. These data demonstrated that CAHs are addressing the growing need through a variety of approaches including the use of innovative models that utilize non‐local providers and telemedicine to expand access to crucial services for rural residents with cancer.

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Disparities in Guideline-Concordant Treatment for Pathologic N1 Non-Small Cell Lung Cancer

Cited by 27 publications

References 25 publications

Racial Disparity and Social Determinants in Receiving Timely Surgery Among Stage I–IIIA Non-small Cell Lung Cancer Patients in a U.S. Southern State

Racial Disparity and Social Determinants in Receiving Timely Surgery Among Stage I–IIIA Non-small Cell Lung Cancer Patients in a U.S. Southern State

A narrative review of lung cancer screening in underserved populations

Availability of cancer care services and the organization of care delivery at critical access hospitals

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