Disparities in guideline-concordant treatment for node-positive, non–small cell lung cancer following surgery

Farrow, Norma E.; An, Selena J.; Speicher, Paul J.; Harpole, David H.; D’Amico, Thomas A.; Klapper, Jacob A.; Hartwig, Matthew G.; Tong, Betty C.

doi:10.1016/j.jtcvs.2019.10.102

Cited by 35 publications

(22 citation statements)

References 46 publications

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“…Lower SES, specifically income and insurance status, on analysis of the National Cancer Database is associated with hospital readmission after surgical resection and readmission after surgical resection has been associated with decreased longterm survival (42,43). For patients who are found to have locoregional disease, it has been shown they are less likely to receive chemotherapy in the adjuvant setting, which improves survival (41,44,45).…”

Section: Discussionmentioning

confidence: 99%

Narrative review of socioeconomic and racial disparities in the treatment of early stage lung cancer

et al. 2021

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Background: To review and discuss the current literature regarding socio-economic and racial disparities in the treatment of early-stage non-small cell lung cancer (NSCLC).Background: Lung cancer is the most lethal solid organ malignancy in the United States, with the secondhighest incidence of new malignances for both men and women. While overall survival for lung cancer is improving, significant socioeconomic and racial disparities in outcomes for lung cancer persist.Methods: Narrative review of peer reviewed literature synthesizing findings retrieved from searches of computerized databases, primary article reference lists, authoritative texts and expert options. Results: The current incidence of lung cancer appears to be similar between White and Black patients.However, Black patients are substantially less likely to receive curative intent surgery. Mitigation strategies do exist to narrow this inequity. Lower socioeconomic status (SES) is associated with a higher incidence of lung cancer, lower utilization of surgery and poorer outcomes after surgery. Conclusions: Race and SES remain closely linked to outcomes in lung cancer. Outcomes are still worse when controlling for stage and specifically, in early-stage disease, surgical therapy is consistently underused in Black patients and patients of low SES.

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Section: Discussionmentioning

confidence: 99%

Narrative review of socioeconomic and racial disparities in the treatment of early stage lung cancer

et al. 2021

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“…[7][8][9][10][11][12] The differences in cancer survival are related to structural barriers to accessing care and overt documented differences in the delivery of evidence-based care. [13][14][15] Patient navigation is a patient-centered intervention designed to improve patient experiences and the delivery of cancer care. Patient navigation is defined as a "community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to care."…”

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confidence: 99%

Navigating a Path to Equity in Cancer Care: The Role of Patient Navigation

Dixit

Rugo

Burke

2021

American Society of Clinical Oncology Educational Book

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Notable barriers exist in the delivery of equitable care for all patients with cancers. Social determinants of health at distal, intermediate, and proximal levels impact cancer care. Patient navigation is a patient-centered intervention that functions across these overlapping determinants to increase access to cancer services throughout the cancer care continuum. There is a need to standardize patient navigation training while remaining responsive to local contexts of care and a need to implement patient navigation programs with a health equity lens to address cancer care inequities.

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“…Often, a study's overarching message is split between its significant findings and the contradiction of what is found not to be significant, which may be the case with the study by Farrow and colleagues. 2 The majority of significant predictors were not "minorities." More specifically, of the numerous significant predictors of nonguideline-concordant care, most did not relate to a classic sociodemographic disparity.…”

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confidence: 98%

“…Despite the established survivorship benefits of adjuvant chemotherapy and chemoradiation for select surgically managed patients with lung cancer, 1 the administration of adjuvant therapy has been frustratingly variable. Farrow and colleagues 2 aimed to evaluate disparities in guideline concordance of adjuvant therapy for patients with pN1 and pN2 non-small cell lung cancer (NSCLC). Prior studies have found correlations between guideline concordance and sociodemographic characteristics such as race, ethnicity, age, and insurance status.…”

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confidence: 99%

“…Although education level was significant, the impact was modest (eg, lowest education quartile unadjusted noncompliant rate ¼ 33% compared with the rest of cohort average of 29%). Without being able to see individual levels within each covariate in the study by Farrow and colleagues, 2 it is not possible to analyze the relationship for each subset (ie, oldest patients, poorest patients, least educated patients), which may have been interesting. For example, if we examine the prevalence within the unadjusted data, we can see that the rate of nonconcordant care was high for the age group greater than 79 years (65.2%), but actually far less so for the age group 70 to 79 years (37.4%).…”

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confidence: 99%

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