Ann Thorac Surg. 2021 May 5:S0003-4975(21)00835-3. doi: 10.1016/j.athoracsur.2021.04.067. Online ahead of print.
BACKGROUND: Non-small cell lung cancer (NSCLC) 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 three or more high-risk socioeconomic factors.
METHODS: The National Cancer Database was queried for patients with clinical stage I-IIA NSCLC diagnosed between 2010-2015. Patients were categorized into three groups: standard treatment, non-standard 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 two-sided.
RESULTS: 93,211 patients met inclusion criteria. For patients with three or more high-risk socioeconomic factors, the odds of non-standard treatment were significantly greater in six regions compared to New England, greatest in West North Central (odds ratio [OR] = 2.09, P<0.001). The odds of no curative treatment were significantly greater in seven regions compared to New England, greatest in West South Central (OR = 3.56, P<0.001). West North Central was associated with the highest risk of all-cause mortality compared to New England (hazard ratio [HR] = 1.10, P<0.001), and Middle Atlantic was associated with the lowest (HR = 0.86, P<0.001). 5-year overall survival was longest in Middle Atlantic (60.8%) and shortest in Mountain (36.8%).
CONCLUSIONS: Patients with three 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 NSCLC patients.