The Academic Facility Type Is Associated With Improved Overall Survival for Early-Stage Lung Cancer

Merritt, Robert E.; Abdel‐Rasoul, Mahmoud; Fitzgerald, Morgan; D’Souza, Desmond M.; Kneuertz, Peter J.

doi:10.1016/j.athoracsur.2020.05.051

Cited by 12 publications

(13 citation statements)

References 21 publications

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“…Academic/research programs are typically highly resourced in comparison with their community facility counterparts, and patients treated at these facilities should be more likely to have access to specialists. 17 As a result of a long history of structural racism in research and medicine, 40 Black patients are more likely than nonminorities to harbor negative treatment beliefs and medical mistrust. 41 Multiple strategies, including financial navigation services and cultural competence and implicit bias training for clinical staff, can be used to improve outcomes among low-SES Black patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 Several studies have shown improved outcomes among patients treated at academic facility types versus community health care facilities for multiple cancer sites, including lung cancer. [17][18][19][20] Among patients with early-stage lung cancer, Black patients who received surgery (which is part of the treatment paradigm for localized lung cancer) at academic facilities experienced better survival than Black and White patients who received surgery at community facilities. 21 Further research is needed to disentangle the mechanisms that produce racial disparities and inform prevention strategies at the health care organization level.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, a study of lung cancer found that Black patients were more likely to be diagnosed at a more advanced stage than White patients across all insurance types with the exception of Medicaid, for which no statistically significant difference was detected 6 . Several studies have shown improved outcomes among patients treated at academic facility types versus community health care facilities for multiple cancer sites, including lung cancer 17–20 . Among patients with early‐stage lung cancer, Black patients who received surgery (which is part of the treatment paradigm for localized lung cancer) at academic facilities experienced better survival than Black and White patients who received surgery at community facilities 21 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of area‐level socioeconomic status and non–small cell lung cancer stage by race/ethnicity and health care–level factors: Analysis of the National Cancer Database

Gupta

Omeogu

Islam

et al. 2022

Cancer

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BACKGROUND:This study examined whether the association of socioeconomic status (SES) and non-small cell lung cancer (NSCLC) stage varied by race/ethnicity and health care access measures. METHODS: This study used data from the 2004-2016 National Cancer Database for patients aged 18-89 years who had been diagnosed with Stage 0-IV NSCLC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for the associations of area-level SES with an advanced stage at diagnosis via multilevel, multivariable logistic regression. The stage at diagnosis was dichotomized into early (0-II) and advanced (III-IV) stages, and area-level SES was categorized on the basis of the patient's zip code level: (1) the proportion of adults aged ≥25 years without a high school degree and (2) the median household income. The models were stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander), insurance status (none, government, and private), and health care facility type (community, comprehensive community, academic/research, and integrated network). RESULTS: The study population included 1,329,972 patients. Although only 17% of the NH White patients were in the lowest income quartile, 50% of the NH Black patients were in this group. Lower area-level education and income were associated with higher odds of an advanced-stage diagnosis (aOR for education, 1.12; 95% CI, 1.10-1.13; aOR for income, 1.13; 95% CI, 1.11-1.14). These associations persisted among NH White, NH Black, Hispanic, and Asian patients; among those with government and private insurance (but not the uninsured); and among those treated at each facility type. CONCLUSIONS: Area-level income and education are strongly associated with an advanced NSCLC diagnosis regardless of the facility type and among those with government and private insurance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of area‐level socioeconomic status and non–small cell lung cancer stage by race/ethnicity and health care–level factors: Analysis of the National Cancer Database

Gupta

Omeogu

Islam

et al. 2022

Cancer

View full text Add to dashboard Cite

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“…Specifically, patients' socioeconomic factors and the type of treating facility are data that are not currently captured in the STS-GTSDB, and which have shown to affect the application of minimally invasive approaches and associated lung cancer surgery outcomes. 31 In addition, the wait time from diagnosis to surgery is not captured in the database and may affect the rate of lymph node upstaging.…”

Section: Discussionmentioning

confidence: 99%

Segmentectomy for clinical stage I non–small cell lung cancer: National benchmarks for nodal staging and outcomes by operative approach

Kneuertz

Abdel‐Rasoul

D’Souza

et al. 2022

Cancer

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BACKGROUND:Segmentectomy is increasingly used for parenchyma sparing anatomical resection for small stage I non-small cell lung cancer (NSCLC). This study characterizes the national outcomes for lymph node assessment and perioperative outcomes of segmentectomy for clinical stage I NSCLC by robotic-assisted surgery (RATS), video-assisted thoracoscopic surgery (VATS), and open thoracotomy approach. METHODS: A retrospective cohort study was conducted of patients who underwent segmentectomy for clinical stage I NSCLC captured in the national Society of Thoracic Surgeons General Thoracic Surgery Database between years 2012 and 2018. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Lymph node (LN) staging and 30-day outcomes were compared by approach. RESULTS: A total of 3680 patients (VATS 61.9%, RATS 20%, open 18%) underwent segmentectomy. The IPTW adjusted rate of pathologic LN upstaging (pN1/pN2) was 6.2% (RATS 6.3%, VATS 5.6%, open 8.6%; P = .05). On multivariate analysis, there was no differences in pN1/N2 upstaging between RATS (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.44-1.49) or VATS (OR, 0.96; 95% CI, 0.57-1.63) with open segmentectomy. The RATS and VATS approach was associated with fewer postoperative events (RATS 31.3%, VATS 28.8%, open 38.3%; P < .001) and shorter length of stay (RATS 4.3 days, VATS 4.4 days, open 5.2 days; P < .001) as compared with thoracotomy. RATS segmentectomy-specific complications included a higher rate of pneumothorax after chest tube removal and discharge with chest tube. Major complications were lower after RATS and VATS as compared with open segmentectomy (RATS 5.9%, VATS 4.5%, open 7.2%; P = .028). CONCLUSIONS: Segmentectomy by VATS and robotic approach resulted in similar high rates of lymph node upstaging as a global marker of the quality of lymph node dissection and were associated with lower overall morbidity and shorter length of stay as compared with open thoracotomy. These national outcomes may serve as benchmarks for future comparative studies.

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“…NCDB is a prospectively maintained registry database covering 70% of newly diagnosed cancer cases in the nation (20). It includes 82% of lung cancer cases with an annual followup of at least 90% of the patients (21). In this current study, we analyzed the survival differences in stage IV SCLC patients between Blacks and Whites, considering various variables available in NCDB.…”

Section: Introductionmentioning

confidence: 99%

Survival of Black and White Patients With Stage IV Small Cell Lung Cancer

et al. 2021

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BackgroundSmall cell lung cancer (SCLC) is associated with aggressive biology and limited treatment options, making this disease a historical challenge. The influence of race and socioeconomic status on the survival of stage IV SCLC remains mostly unknown. Our study is designed to investigate the clinical survival outcomes in Black and White patients with stage IV SCLC and study the demographic, socioeconomic, clinical features, and treatment patterns of the disease and their impact on survival in Blacks and Whites.Methods and ResultsStage IV SCLC cases from the National Cancer Database (NCDB) diagnosed between 2004 and 2014 were obtained. The follow-up endpoint is defined as death or the date of the last contact. Patients were divided into two groups by white and black. Features including demographic, socioeconomic, clinical, treatments and survival outcomes in Blacks and Whites were collected. Mortality hazard ratios of Blacks and Whites stage IV SCLC patients were analyzed. Survival of stage IV SCLC Black and White patients was also analyzed. Adjusted hazard ratios were analyzed by Cox proportional hazards regression models. Patients’ median follow-up time was 8.18 (2.37-15.84) months. Overall survival at 6, 12, 18 and 24 months were 52.4%, 25.7%, 13.2% and 7.9% in Blacks in compared to 51.0%, 23.6%, 11.5% and 6.9% in Whites. White patients had significantly higher socioeconomic status than Black patients. By contrast, Blacks were found associated with younger age at diagnosis, a significantly higher chance of receiving radiation therapy and treatments at an academic/research program. Compared to Whites, Blacks had a 9% decreased risk of death.ConclusionOur study demonstrated that Blacks have significant socioeconomic disadvantages compared to Whites. However, despite these unfavorable factors, survival for Blacks was significantly improved compared to Whites after covariable adjustment. This may be due to Blacks with Stage IV SCLC having a higher chance of receiving radiation therapy and treatments at an academic/research program. Identifying and removing the barriers to obtaining treatments at academic/research programs or improving the management in non-academic centers could improve the overall survival of stage IV SCLC.

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The Academic Facility Type Is Associated With Improved Overall Survival for Early-Stage Lung Cancer

Cited by 12 publications

References 21 publications

Association of area‐level socioeconomic status and non–small cell lung cancer stage by race/ethnicity and health care–level factors: Analysis of the National Cancer Database

Association of area‐level socioeconomic status and non–small cell lung cancer stage by race/ethnicity and health care–level factors: Analysis of the National Cancer Database

Segmentectomy for clinical stage I non–small cell lung cancer: National benchmarks for nodal staging and outcomes by operative approach

Survival of Black and White Patients With Stage IV Small Cell Lung Cancer

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