Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival

Atkins, Graham; Kim, Taeha; Munson, Jeffrey C.

doi:10.1513/annalsats.201606-469oc

Cited by 127 publications

(133 citation statements)

References 25 publications

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“…Similar to our findings, a recent study using national SEER‐Medicare data demonstrated no relationship between rurality and stage at diagnosis . In contrast, others have reported more advanced‐stage disease in rural patients presenting with lung cancer .…”

Section: Discussionsupporting

confidence: 90%

“…Lung cancer is the leading cause of cancer death in the United States among men and women . In rural areas, lung cancer mortality is up to 20% higher than in metropolitan areas . Maine, the most rural state, has the 5th highest lung cancer incidence in the United States and the highest in New England .…”

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confidence: 99%

“…Several factors contribute to the high burden of lung cancer in rural areas, including disproportionately higher smoking rates . Additionally, residents of rural areas may have less access to public health interventions and health care services aimed at lung cancer prevention, screening, and treatment …”

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confidence: 99%

“…Differential access to evidence‐based care may be another driver of lung cancer mortality in rural states. A recent analysis of SEER‐Medicare data showed a dose‐response relationship between degree of rurality and lung cancer mortality . Furthermore, there were fewer surgeries for patients with early‐stage disease who could have potentially benefitted from treatment .…”

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confidence: 99%

“…A recent analysis of SEER‐Medicare data showed a dose‐response relationship between degree of rurality and lung cancer mortality . Furthermore, there were fewer surgeries for patients with early‐stage disease who could have potentially benefitted from treatment . Other studies, however, have found that regional differences in socioeconomic status and supply of medical care predict lung cancer survival, whereas rurality does not …”

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confidence: 99%

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Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness

Fairfield

Black

Lucas

et al. 2019

The Journal of Rural Health

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Background Lung cancer is the leading cause of cancer‐related mortality in the United States, and rural states bear a greater burden of disease. Methods We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural‐urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage. Results We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early‐stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late‐stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08‐2.02) than those in metropolitan areas. Patients with early‐stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22‐68) compared with large rural (34 days, IQR 17‐55) and metropolitan areas (35 days, IQR 17‐60), P = .0009. Conclusion Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness

Fairfield

Black

Lucas

et al. 2019

The Journal of Rural Health

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Evaluation of Lung Cancer Risk Among Persons Undergoing Screening or Guideline-Concordant Monitoring of Lung Nodules in the Mississippi Delta

Osarogiagbon¹,

Liao²,

Faris³

et al. 2023

JAMA Netw Open

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ImportanceGuideline-concordant management of lung nodules promotes early lung cancer diagnosis, but the lung cancer risk profile of persons with incidentally detected lung nodules differs from that of screening-eligible persons.ObjectiveTo compare lung cancer diagnosis hazard between participants receiving low-dose computed tomography screening (LDCT cohort) and those in a lung nodule program (LNP cohort).Design, Setting, and ParticipantsThis prospective cohort study included LDCT vs LNP enrollees from January 1, 2015, to December 31, 2021, who were seen in a community health care system. Participants were prospectively identified, data were abstracted from clinical records, and survival was updated at 6-month intervals. The LDCT cohort was stratified by Lung CT Screening Reporting and Data System as having no potentially malignant lesions (Lung-RADS 1-2 cohort) vs those with potentially malignant lesions (Lung-RADS 3-4 cohort), and the LNP cohort was stratified by smoking history into screening-eligible vs screening-ineligible groups. Participants with prior lung cancer, younger than 50 years or older than 80 years, and lacking a baseline Lung-RADS score (LDCT cohort only) were excluded. Participants were followed up to January 1, 2022.Main Outcomes and MeasuresComparative cumulative rates of lung cancer diagnosis and patient, nodule, and lung cancer characteristics between programs, using LDCT as a reference.ResultsThere were 6684 participants in the LDCT cohort (mean [SD] age, 65.05 [6.11] years; 3375 men [50.49%]; 5774 [86.39%] in the Lung-RADS 1-2 and 910 [13.61%] in the Lung-RADS 3-4 cohorts) and 12 645 in the LNP cohort (mean [SD] age, 65.42 [8.33] years; 6856 women [54.22%]; 2497 [19.75%] screening eligible and 10 148 [80.25%] screening ineligible). Black participants constituted 1244 (18.61%) of the LDCT cohort, 492 (19.70%) of the screening-eligible LNP cohort, and 2914 (28.72%) of the screening-ineligible LNP cohort (P &lt; .001). The median lesion size was 4 (IQR, 2-6) mm for the LDCT cohort (3 [IQR, 2-4] mm for Lung-RADS 1-2 and 9 [IQR, 6-15] mm for Lung-RADS 3-4 cohorts), 9 (IQR, 6-16) mm for the screening-eligible LNP cohort, and 7 (IQR, 5-11) mm for the screening-ineligible LNP cohort. In the LDCT cohort, lung cancer was diagnosed in 80 participants (1.44%) in the Lung-RADS 1-2 cohort and 162 (17.80%) in the Lung-RADS 3-4 cohort; in the LNP cohort, it was diagnosed in 531 (21.27%) in the screening-eligible cohort and 447 (4.40%) in the screening-ineligible cohort. Compared with Lung-RADS 1-2, the fully adjusted hazard ratios (aHRs) were 16.2 (95% CI, 12.7-20.6) for the screening-eligible cohort and 3.8 (95% CI, 3.0-5.0) for the screening-ineligible cohort; compared with Lung-RADS 3-4, the aHRs were 1.2 (95% CI, 1.0-1.5) and 0.3 (95% CI, 0.2-0.4), respectively. The stage of lung cancer was I to II in 156 of 242 patients (64.46%) in the LDCT cohort, 276 of 531 (52.00%) in the screening-eligible LNP cohort, and 253 of 447 (56.60%) in the screening-ineligible LNP cohort.Conclusions and RelevanceIn this cohort study, the cumulative lung cancer diagnosis hazard of screening-age persons enrolled in the LNP was higher than that in a screening cohort, irrespective of smoking history. The LNP provided access to early detection for a higher proportion of Black persons.

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Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial

et al. 2018

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Annual chest computed tomography (CT) can decrease lung cancer mortality in high‐risk individuals. Patient navigation improves cancer screening rates in underserved populations. Randomized controlled trial was conducted from February 2016 to January 2017 to evaluate the impact of a patient navigation program on lung cancer screening (LCS) among current smokers in five community health centers (CHCs) affiliated with an academic primary care network. We randomized 1200 smokers aged 55–77 years to intervention (n = 400) or usual care (n = 800). Navigators contacted patients to determine LCS eligibility, introduce shared decision making about screening, schedule appointments with primary care physicians (PCPs), and help overcome barriers to obtaining screening and follow‐up. Control patients received usual care. The main outcome was the proportion of patients who had any chest CT. Secondary outcomes were the proportion of patients contacted, proportion receiving LCS CTs, screening results and number of lung cancers diagnosed. Of the 400 intervention patients, 335 were contacted and 76 refused participation. Of the 259 participants, 124 (48%) were ineligible for screening; 119 had smoked <30 pack‐years, and five had competing comorbidities. Among the 135 eligible participants in the intervention group, 124 (92%) had any chest CT performed. In intention‐to‐treat analyses, 124 intervention patients (31%) had any chest CT versus 138 control patients (17.3%, P < 0.001). LCS CTs were performed in 94 intervention patients (23.5%) versus 69 controls (8.6%, P < 0.001). A total of 20% of screened patients required follow‐up. Lung cancer was diagnosed in eight intervention (2%) and four control (0.5%) patients. A patient navigation program implemented in CHCs significantly increased LCS among high‐risk current smokers.

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Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival

Cited by 127 publications

References 25 publications

Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness

Association Between Rurality and Lung Cancer Treatment Characteristics and Timeliness

Evaluation of Lung Cancer Risk Among Persons Undergoing Screening or Guideline-Concordant Monitoring of Lung Nodules in the Mississippi Delta

Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial

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