Public assistance and survival equality in patients with EGFR mutation-positive lung cancer

Abstract

Background Disparities in public assistance or the urbanization level of a residential region can affect cancer treatment outcomes. This study aimed to investigate whether these factors affect the overall survival (OS) of patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) using Tokushukai REAL World Data. Methods We analyzed the clinical data of consecutive patients with NSCLC receiving EGFR-tyrosine kinase inhibitors between April 2010 and March 2020 at 46 Tokushukai Medical Group hospitals in Japan. The patient’s insurance coverage status was extracted from electronic medical records, and the urbanization level of residential regions was classified as megalopolis or other according to the secondary medical region. Univariate and multivariate Cox regression analyses were performed to examine the associations between OS and patient/tumor/treatment/socioeconomic-related factors. Results In total, 758 patients (58.5% females) were included in the study; 41 patients (5.4%) received public assistance, and 442 patients (58.3%) were categorized under megalopolis in the secondary medical regions. In multivariate Cox regression analyses, there was no significant difference in the OS between non-recipients of public assistance and recipients [hazard ratio (HR) 1.084; 95% confidence intervals (CIs), 0.674–1.744]. There was also no significant difference in the OS between megalopolis and other regions in the secondary medical regions (HR 1.143; 95% CIs, 0.914–1.428). Conclusions Our findings suggest that neither the use of public assistance nor the urbanization level in the residential region significantly impacts the prognosis of Japanese patients with EGFR mutation-positive NSCLC.