Rural Disparities in Lung Cancer-directed Surgery

Abstract

Objective: The primary objective of this study was to determine the influence of rural residence on access to and outcomes of lung cancer-directed surgery for Medicare beneficiaries. Summary of Background Data: Lung cancer is the leading cause of cancerrelated death in the United States and rural patients have 20% higher mortality. Drivers of rural disparities along the continuum of lung cancercare delivery are poorly understood. Methods: Medicare claims (2015–2018) were used to identify 126,352 older adults with an incident diagnosis of nonmetastatic lung cancer. Rural Urban Commuting Area codes were used to define metropolitan, micropolitan, small town, and rural site of residence. Multivariable logistic regression models evaluated influence of place of residence on 1) receipt of cancer-directed surgery, 2) time from diagnosis to surgery, and 3) postoperative outcomes. Results: Metropolitan beneficiaries had higher rate of cancer-directed surgery (22.1%) than micropolitan (18.7%), small town (17.5%), and isolated rural (17.8%) (P < 0.001). Compared to patients from metropolitan areas, there were longer times from diagnosis to surgery for patients living in micropolitan, small, and rural communities. Multivariable models found nonmetropolitan residence to be associated with lower odds of receiving cancer-directed surgery and MIS. Nonmetropolitan residence was associated with higher odds of having postoperative emergency department visits. Conclusions: Residence in nonmetropolitan areas is associated with lower probability of cancer-directed surgery, increased time to surgery, decreased use of MIS, and increased postoperative ED visits. Attention to timely access to surgery and coordination of postoperative care for nonmetropolitan patients could improve care delivery.

Exploring Inflammatory Parameters in Lung Cancer Patients: A Retrospective Analysis

“…Due to the reluctance of rural patients toward the medical system, they typically seek hospital care when symptoms become unbearable, often at more advanced stages of the disease, thus increasing the risk of postoperative complications. Consequently, urban patients tend to seek screening and consultations more promptly in the early stages of the disease, leading to a treatment with a more favorable outcome and a lower rate of complications [ 44 ].…”

Health inequities across the lung cancer care continuum in ten marginalized populations: a narrative review

“…Rural residents are more likely to not receive treatment ( 74 ), including chemotherapy or radiotherapy ( 75 ). When treatment is provided, rural populations have lower odds of receiving cancer-directed surgery ( 76 ), and receive less guideline-concordant treatment when compared to metropolitan residents ( 75 ). In general, there are delays in treatment and increased time from diagnosis to surgery, especially for early-stage patients in small/isolated rural areas ( 77 ).…”