Rurality, Stage-Stratified Use of Treatment Modalities, and Survival of Non-small Cell Lung Cancer

Ray, Meredith; Faris, Nicholas R.; Derrick, Anna; Smeltzer, Matthew; Osarogiagbon, Raymond U.

doi:10.1016/j.chest.2020.04.042

Cited by 25 publications

(23 citation statements)

References 28 publications

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“…However, the care and outcome disparity problem continues unabated. 6,[17][18][19] Examination of institution-level outcome disparities in early-stage non-small cell lung cancer (NSCLC) has focused mainly on postoperative mortality: the risk of failing to survive the cancer operation. [20][21][22] However, most lung cancer patients who undergo surgery survive the operation.…”

mentioning

confidence: 99%

Institutional-Level Differences in Quality and Outcomes of Lung Cancer Resections in the United States

Osarogiagbon

Sineshaw

Lin

et al. 2021

Chest

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confidence: 99%

Institutional-Level Differences in Quality and Outcomes of Lung Cancer Resections in the United States

Osarogiagbon

Sineshaw

Lin

et al. 2021

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“…This was not the case in the regional non-MTOC patients, for whom rural cancer care delivery might pose additional challenges. 20 , 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…This was not the case in the regional non-MTOC patients, for whom rural cancer care delivery might pose additional challenges. 20,26,27 We provide robust evidence for survival benefit from multidisciplinary decision-making. Reasons for the survival benefit of eMTOC decision-making may include improved staging, higher rates of delivery of guidelineconcordant care, in particular, stage-preferred treatment (such as surgical resection for early stage and multimodality therapy for stage III NSCLC).…”

Section: Discussionmentioning

confidence: 99%

“…19 We also identified patient-level rurality on the basis of each patient’s zip code of residence at the time of lung cancer diagnosis. 20 …”

Section: Methodsmentioning

confidence: 99%

“…19 We also identified patient-level rurality on the basis of each patient's zip code of residence at the time of lung cancer diagnosis. 20 Using National Comprehensive Cancer Network guidelines, we categorized treatment as "stagepreferred" when the primary treatment for patients with that clinical stage was administered and "stage-appropriate" to include alternative evidence-based treatment modalities which might be received under certain circumstances (Supplementary Table A.1). 21 Stage was based on the seventh edition of the American Joint Committee on Cancer definitions.…”

Section: Methodsmentioning

confidence: 99%

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Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System

Ray

Faris

Fehnel

et al. 2021

JTO Clinical and Research Reports

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Introduction We compared NSCLC treatment and survival within and outside a multidisciplinary model of care from a large community health care system. Methods We implemented a rigorously benchmarked “enhanced” Multidisciplinary Thoracic Oncology Conference (eMTOC) and used Tumor Registry data (2011–2017) to evaluate guideline-concordant care. Because eMTOC was located in metropolitan Memphis, we separated non-MTOC patient by metropolitan and regional location. We categorized National Comprehensive Cancer Network guideline-concordant treatment as “preferred,” or “appropriate” (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-square tests and survival using Cox regression, adjusted for multiple testing. We also performed propensity-matched and adjusted survival analyses. Results Of 6259 patients, 14% were in eMTOC, 55% metropolitan non-MTOC, and 31% regional non-MTOC cohorts. eMTOC had the highest rates of African Americans (34% versus 28% versus 22%), stages I to IIIB (63 versus 40 versus 50), urban residents (81 versus 78 versus 20), stage-preferred treatment (66 versus 57 versus 48), guideline-concordant treatment (78 versus 70 versus 63), and lowest percentage of nontreatment (6 versus 21 versus 28); all p values were less than 0.001. Compared with eMTOC, hazard for death was higher in metropolitan (1.5, 95% confidence interval: 1.4–1.7) and regional (1.7, 1.5–1.9) non-MTOC; hazards were higher in regional non-MTOC versus metropolitan (1.1, 1.0–1.2); all p values were less than 0.05 after adjustment. Results were generally similar after propensity analysis with and without adjusting for guideline-concordant treatment. Conclusions Multidisciplinary NSCLC care planning was associated with significantly higher rates of guideline-concordant care and survival, providing evidence for rigorous implementation of this model of care.

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Racial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER)

et al. 2022

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IMPORTANCE Considering reported rural-urban cancer incidence and mortality trends, rural-urban cancer survival trends are important for providing a comprehensive description of cancer burden. Furthermore, little is known about rural-urban differences in survival trends by racial and ethnic groups.OBJECTIVE To examine national rural-urban trends in 5-year cancer-specific survival probabilities for lung, prostate, breast, and colorectal cancers in a diverse sample of racial and ethnic groups. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used an epidemiologic assessment with 1975 to 2016 Surveillance, Epidemiology, and End Results (SEER) data to analyze patients diagnosed no later than 2011. Patients were classified as living in rural and urban counties based on the 2013 Rural-Urban Continuum Codes. MAIN OUTCOMES AND MEASURES The 5-year cancer-specific survival probability of urban and rural patients for each cancer type was estimated by fitting Cox proportional hazard regression models accounting for race, ethnicity, tumor characteristics, and other sociodemographic characteristics. A generalized linear regression model was used to estimate the mean estimated probability of survival for each stratum. Joinpoint regression analysis estimated periods of significant change in survival. RESULTSIn this study, data from 3 659 417 patients with cancer (median [IQR] age, 67 [58-76]; 1 918 609 [52.4%] male; 237 815 [6.5%] Hispanic patients; 396 790 [10.8%] Black patients; 2 825 037 [77.2%] White patients) were analyzed, including 888 338 patients with lung cancer (24.3%), 750 704 patients with colorectal cancer (20.5%), 987 826 patients with breast cancer(27.0%), and 1 023 549 patients with prostate cancer (28.0%). There were 430 353 rural patients (11.8%). Overall, there was an equal representation of rural and urban men. Rural patients were likely to be non-Hispanic White individuals, have more cases of distant tumors, and be older. Rural and non-Hispanic Black patients for all cancer types often had shorter survival. From 1975 to 2016, the 5-year lung cancer survival rate was shorter for non-Hispanic Black rural patients in 1975 at 48%, while increasing to 57% for both non-Hispanic Black urban and rural patients in 2011, but still the shortest among all cancer types. In 1975, the longest survival rate was observed in urban Asian and Pacific Islander patients with breast cancer at 86%, and in 2011, the longest survival rate was observed in urban non-Hispanic White patients at 92%. CONCLUSIONS AND RELEVANCEEven after accounting for sociodemographic and tumor characteristics, these findings suggest that non-Hispanic Black patients with cancer are particularly (continued) Key Points Question What are the rural-urban trends in overall and cancer-specific survival across the most prevalent cancer types (ie, lung, prostate, breast, and colorectal cancers)? Findings This cross-sectional study of 3 659 417 patients with cancer used an epidemiological assessment of 1975 to 2011 data from the SEER database and found t...

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Rurality, Stage-Stratified Use of Treatment Modalities, and Survival of Non-small Cell Lung Cancer

Cited by 25 publications

References 28 publications

Institutional-Level Differences in Quality and Outcomes of Lung Cancer Resections in the United States

Institutional-Level Differences in Quality and Outcomes of Lung Cancer Resections in the United States

Survival Impact of an Enhanced Multidisciplinary Thoracic Oncology Conference in a Regional Community Health Care System

Racial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER)

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