Social determinants and facility type impact adherence to best practices in operable IIIAN2 lung cancer

Abstract

OBJECTIVES We aimed to identify patient- and facility-specific predictors of collective adherence to 4 recommended best treatment practices in operable IIIAN2 non-small-cell lung cancer (NSCLC) and test the hypothesis that collective adherence is associated with superior survival. METHODS We queried the National Cancer Database for clinical stage IIIAN2 NSCLC patients undergoing surgery during 2010–2015. The following best practices were examined: performance of an anatomic resection, performance of an R0 resection, examination of regional lymph nodes and administration of induction therapy. Multivariable regression models were fitted to identify independent predictors of guideline-concordance. RESULTS We identified 7371 patients undergoing surgical resection for IIIAN2 lung cancer, of whom 90.8% underwent an anatomic resection, 88.2% received an R0 resection, 92.5% underwent a regional lymph node examination, 41.6% received induction therapy and 33.7% received all 4 best practices. Higher income, private insurance and treatment at an academic facility were independently associated with adherence to all 4 best practices (P < 0.01). A lower level of education and residence in a rural county were associated with a lack of adherence (P < 0.05). Adherence to all 4 practices correlated with improved survival (P < 0.01). CONCLUSIONS National adherence to best treatment practices in operable IIIAN2 lung cancer was variable as evidenced by the majority of patients not receiving recommended induction therapy. Socioeconomic factors and facility type are important determinants of guideline-concordance. Future efforts to improve outcomes should take this into account since guideline concordance, in the form of collective adherence to all 4 best practices, was associated with improved survival.

Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients

“…Moreover, most observed comorbidities were chronic and being treated. Occupational skill level did not significantly affect the likelihood of receiving guideline adherent treatment, in contrast to an earlier report, which found that lower educational level and residence in a rural county were associated with a lack of adherence to guidelines in patients with stage III NSCLC [23]. In our study population, only 9.0% of the NSCLC patients had a high occupational level, a much lower percentage than in the general population of Ostrobothnia [24].…”

Treatment discordance in the utilization of neck dissection for stage I‐II supraglottic tumors

“…Academic centers had higher rates of performing neck dissection. This is consistent with previous studies that have shown that academic centers may more often provide guideline-concordant treatment for patients, [24][25][26][27] potentially due to a variety of factors including better access to resources such as highly specialized providers, and differences in patient preferences and tumor presentations at academic and community facilities. This may be particularly important when considering that certain populations of patients may have limited access to academic medical centers.…”

Treatment quality and outcomes vary with hospital burden of uninsured and Medicaid patients with cancer in early non–small cell lung cancer

“… 17 , 19 This finding is unexpected and interesting given that academic centers are widely reported to have superior survival outcomes in NSCLC by virtue of being more guideline concordant than other center types. 1 , 24 This suggests that achieving better outcomes in this group of patients is an exceedingly complex and multifactorial process and one that clearly needs further study.…”

“…Social determinants of health impact treatment quality and survival in patients with non–small cell lung cancer (NSCLC). 1 , 2 Safety-net hospitals have previously been grouped with other proposed patient- and facility-specific contributors of these healthcare disparities. 3 The Institute of Medicine defines safety-net hospitals as “those providers that organize and deliver a significant level of health care and other related services to uninsured, Medicaid, and other vulnerable patients.” 4 Safety-net hospitals have been associated with reduced adherence to quality-of-care measures and a lower use of curative-intent surgery in patients with NSCLC.…”