Disparities in Access to Video-Assisted Thoracic Surgical Lobectomy for Treatment of Early-Stage Lung Cancer

Stitzenberg, Karyn B.; Shah, Prasun; Snyder, Justin; Scott, Walter J.

doi:10.1089/lap.2012.0095

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…In this study, we found that the VATS approach was more expensive than the open approach. Several previous reports have demonstrated that the costs of VATS lobectomy were lower than open thoracotomy because of shorter hospital stay (21)(22)(23)(24)(25)(26)(27). Most of these studies were from developed countries.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Mei¹,

Guo²,

Xia³

et al. 2019

Transl. Lung Cancer Res

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Background: Video-assisted thoracic surgery (VATS) has been considered as the better choice for the surgical treatment of resectable non-small cell lung cancer (NSCLC). This study aimed to evaluate the short-and long-term outcomes of VATS versus open thoracotomy lobectomy for patients with pathological stage (p-stage) I-II NSCLC in one of the high-volume center in China. Methods: Perioperative outcomes and long-term survival of patients who underwent VATS versus open lobectomies for p-stage I-II NSCLC from May 2006 to June 2013 in the Western China Lung Cancer Database (WCLCD) were studied using propensity score matching (PSM). The VATS lobectomy was mainly carried out using the single-direction technique. Results: Of the 3,678 patients who underwent surgery for lung malignancies, 1,485 patients with stage I-II NSCLC were enrolled for the study, including 737 cases of VATS lobectomies and 748 cases of open lobectomies. PSM resulted in 464 cases of VATS lobectomies and 464 cases of open lobectomies who were well matched by ten potential prognostic factors including tumor size, T-and N-stage. VATS lobectomy was associated with less blood loss than open surgery (median: 60 vs. 100 mL, P=0.000), as well as fewer postoperative complications (15.1% vs. 20.3%, P=0.039). In addition, the VATS approach removed more lymph node stations (4.9±1.5 vs. 4.2±1.8, P=0.000). The postoperative hospital stay was shorter in the VATS group (7.7±3.8 vs. 8.3±4.3, P=0.019), but the total hospital costs were more expensive (48.4±11.3 vs. 35.5±9.4 kRMB, P=0.000). The matched cohorts revealed that VATS lobectomy for stage I-II NSCLC had improved 5-year overall survival (OS) than the open approach (71.1% vs. 65.4%, P=0.045). Conclusions: The VATS lobectomy is associated with less blood loss, fewer postoperative complications, and shorter postoperative hospital stay when comparing with the open approach for stage I-II NSCLC. Despite more hospital costs, VATS lobectomy offer improved 5-year OS than the open approach. It is reasonable to recommend the VATS approach as the preferred option for the surgical treatment of stage I-II NSCLC.

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Section: Discussionmentioning

confidence: 99%

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Mei¹,

Guo²,

Xia³

et al. 2019

Transl. Lung Cancer Res

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“…In addition to the variability in access to care as measured by distance to facility or facility type and/or volume, it was notable that an urban-rural divide may play a role. Our sample has too few 4 However, previous suggestions of combining initial diagnostics locally with coordination and continuity of care at referral facilities may mitigate some of the access to care disparities revealed in our analysis. 11 Policy makers and health care system architects should continue addressing disparities in access to surgery and multimodality therapy to ensure equity of care for patients with MPM.…”

Section: Jama Network Open | Oncologymentioning

confidence: 74%

“…Similar findings related to median zip code income have been reported for surgical treatment in early-stage lung cancer. 4 Moreover, additional SDOHs, such as level of education, have yet to be evaluated systematically in MPM, although they have been identified in other thoracic tumor types, such as tracheal cancer. 5 Furthermore, although the distance to treatment is associated with survival rates in multiple reports, access to treatment for patients with MPM should be studied.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Survival Due to Social Determinants of Health and Access to Treatment in US Patients With Operable Malignant Pleural Mesothelioma

et al. 2023

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ImportanceOutcomes of localized malignant pleural mesothelioma (MPM) remain poor despite multimodality therapy. It is unclear what role disparities have in the overall survival (OS) of patients with operable MPM.ObjectiveTo examine survival disparities associated with social determinants of health (SDOHs) and treatment access in patients with malignant pleural mesothelioma.Design, Setting, and ParticipantsIn this observational, retrospective cohort study, patients with MPM diagnosed between January 1, 2004, and December 31, 2017, were identified from the National Cancer Database with a maximum follow-up time of 13.6 years. The analysis was conducted from February 16, 2022, to July 29, 2022. Patients were included if they were diagnosed with potentially resectable clinical stage I to IIIA MPM, had epithelioid and biphasic histologic subtypes, and received chemotherapy. Patients were excluded if they could not receive curative surgery, were 75 years or older, or had metastasis, unknown stage, or tumor extension to the chest wall, mediastinal tissues, or organs.ExposuresChemotherapy alone vs chemotherapy with curative surgery in the form of pleurectomy and decortication or extrapleural pneumonectomy.Main Outcomes and MeasuresThe primary end point was OS. Cox proportional hazards regression models were used to determine hazard ratios (HRs) for OS, including univariable and multivariable models controlling for potential confounders, including demographic, comorbidity, clinical, treatment, tumor, and hospital-related variables, as well as SDOHs.ResultsA total of 1389 patients with MPM were identified (median [IQR] age, 66 [61-70] years; 1024 [74%] male; 12 [1%] Asian, 49 [3%] Black, 74 [5%] Hispanic, 1233 [89%] White, and 21 [2%] of other race). The median OS was 1.7 years (95% CI, 1.6-1.8). Risk factors associated with worse OS included older age, male sex, Black race, low income, and low educational attainment. Factors associated with greater odds of survival included receipt of surgical therapy, recent year of treatment, increased distance to travel, and treatment at high-volume academic hospitals. The risk factors most strongly associated with poor OS included Black race (HR, 1.96; 95% CI, 1.43-2.69) and male sex (HR, 1.60; 95% CI, 1.38-1.86). Surgical treatment in addition to systemic chemotherapy (HR, 0.70; 95% CI, 0.61-0.81) was independently associated with improved OS, as were chemotherapy initiation (HR, 0.93; 95% CI, 0.87-0.99) and greater travel distance from the hospital (HR, 0.92; 95% CI, 0.86-0.98).Conclusions and RelevanceIn this retrospective cohort study of patients with operable MPM, there was significant variability in access to care by SDOHs. Addressing disparities in access to multimodality therapy can help ensure equity of care for patients with MPM.

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“…African–Americans were least likely to receive a MI approach, along with those on Medicaid or living in rural communities. This correlation has been published utilizing inpatient discharge claims data as far back as 2008, 17 and other hospital database studies have shown a link between low socioeconomic status and readmission rates 18 . Diversity, equity, and inclusion has become a focus of the major surgical societies.…”

Section: Discussionmentioning

confidence: 91%

Trends and factors affecting approach choice to pulmonary resection

Mitzman

Wang

Haaland

et al. 2022

Journal of Surgical Oncology

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Background The development of an advanced robotic platform in 2014 led to increased adoption of minimally invasive (MI) approaches in thoracic surgery. Due to dataset reporting lag, a comprehensive assessment of trends in thoracic approaches has not been analyzed to date. Methods We queried the National Cancer Database (NCDB) for patients with Stage I–III who underwent lung resection from 2010 to 2018. Most published NCDB analyses on lung cancer using pre‐2015 data. Overall treatment trends were analyzed, with geographic, institutional, and socioeconomic characteristics evaluated for approach. Results There were 162 335 lung resections, and 131 958 were anatomic. Robotic resection saw a steady increase through 2012 but plateaued in 2013–2014. From 2015 to 2018, another increase correlated with the release of a new platform. Video‐assisted thoracoscopic surgery lung resection plateaued in 2014 and decreased in 2018. Open resection steadily decreased. Tumors requiring neoadjuvant radiation had an increase in MI approach with corresponding decreases in the open. On multivariable analysis, African–American race, low volume, Medicaid insurance, and nonacademic setting were associated with a lower likelihood of MI surgery. Conclusions The open approach has decreased since 2010. More than 65% of anatomic resections are now performed in MI. As this trend will continue, it is important that all patients are afforded the opportunity of the least invasive approach.

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Disparities in Access to Video-Assisted Thoracic Surgical Lobectomy for Treatment of Early-Stage Lung Cancer

Abstract: For the period studied, patients in rural areas, in low-volume hospitals, who had Medicaid, or with lower median incomes underwent VATS lobectomy less often.

Cited by 15 publications

References 12 publications

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Disparities in Survival Due to Social Determinants of Health and Access to Treatment in US Patients With Operable Malignant Pleural Mesothelioma

Trends and factors affecting approach choice to pulmonary resection

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