Type and case volume of health care facility influences survival and surgery selection in cases with early‐stage non–small cell lung cancer

Abstract

Background With the expansion of non–small cell lung cancer (NSCLC) screening methods, the percentage of cases with early‐stage NSCLC is anticipated to increase. Yet it remains unclear how the type and case volume of the health care facility at which treatment occurs may affect surgery selection and overall survival for cases with early‐stage NSCLC. Methods A total of 332,175 cases with the American Joint Committee on Cancer (AJCC) TNM stage I and stage II NSCLC who were reported to the National Cancer Data Base (NCDB) by 1302 facilities were studied. Facility type was characterized in the NCDB as community cancer program (CCP), comprehensive community cancer program (CCCP), academic/research program (ARP), or integrated network cancer program (INCP). Each facility type was dichotomized further into high‐volume or low‐volume groups based on the case volume. Multivariate Cox proportional hazard models, the logistic regression model, and propensity score matching were used to evaluate differences in survival and surgery selection among facilities according to type and volume. Results Cases from ARPs were found to have the longest survival (median, 16.4 months) and highest surgery rate (74.8%), whereas those from CCPs had the shortest survival (median, 9.7 months) and the lowest surgery rate (60.8%). The difference persisted when adjusted by potential confounders. For cases treated at CCPs, CCCPs, and ARPs, high‐volume facilities had better survival outcomes than low‐volume facilities. In facilities with better survival outcomes, surgery was performed for a greater percentage of cases compared with facilities with worse outcomes. Conclusions For cases with early‐stage NSCLC, both facility type and case volume influence surgery selection and clinical outcome. Higher surgery rates are observed in facilities with better survival outcomes.

Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database

“…A larger proportion of patients with Medicaid or no insurance was treated at a community cancer center (9.3% and 6.3%, respectively), compared to patients with Medicare or private insurance (4.2% and 3.2%, respectively). Facility type has been noted to be an independent factor affecting prognosis in other cancers [21][22][23], with community cancer centers usually having poorer overall survival when compared to academic/research programs, comprehensive community cancer programs, or integrated network cancer programs. Furthermore, facility volume is often correlated with facility type.…”

The volume–outcome relationship in lung cancer surgery: The impact of the social determinants of health care delivery

“…3 Nearly onethird of lung cancer operations are performed by general surgeons, with a majority done in nonacademic settings. 3,4 This heterogeneity creates an opportunity to improve outcomes through centralization of lung cancer surgery, with volume cutoffs to ensure adequate experience. 5,6 The data show no clear relationship between using volume minimums and improved outcomes, however.…”

“…The STS-GTSD disproportionally selects for patients who receive their care at metropolitan academic centers, which are more likely to be higher-volume centers for lung cancer resection to begin with, and have been associated with better short-and long-term outcomes for lung cancer. 4 For example, that national literature demonstrates that 8% of patients receive lung cancer surgical care at a facility meeting both hospital and surgeon standards, and yet 52% of the study population of Farjah and associates met these standards. 8,12 The overrepresentation of patients from highvolume academic centers within the STS-GTSD ignores well documented income, geographic, racial/ethnic, and insurance disparities in terms of receipt of lung cancer surgery, as well as access to high-volume centers.…”

“…Most studies of volume and outcome, including those of the VP, focus on short-term outcomes that are easily definable, such as mortality. [3][4][5][6][7][8] Farjah and associates analyze 30-day mortality, complications, and failure to rescue (FTR). These outcomes are clearly important and have face validity in evaluating quality, but a total focus on these more easily measureable outcomes might not give a full picture of the value of a policy such as the VP.…”

Association of area‐level socioeconomic status and non–small cell lung cancer stage by race/ethnicity and health care–level factors: Analysis of the National Cancer Database

“…6 Several studies have shown improved outcomes among patients treated at academic facility types versus community health care facilities for multiple cancer sites, including lung cancer. [17][18][19][20] Among patients with early-stage lung cancer, Black patients who received surgery (which is part of the treatment paradigm for localized lung cancer) at academic facilities experienced better survival than Black and White patients who received surgery at community facilities. 21 Further research is needed to disentangle the mechanisms that produce racial disparities and inform prevention strategies at the health care organization level.…”