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Liora Sahar

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-53 - County-Level Variations and Contributing Factors in Receipt of Surgery for Early-Stage Non-Small Cell Lung Cancer in the US (ID 13313)

      16:45 - 18:00  |  Author(s): Liora Sahar

      • Abstract


      Previous studies have reported geographic variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states or regions in the United States. However, little is known about the extent of county-level variations in the receipt of care within and across states, and factors contributing to these variations. We examined county-level variations in receipt of curative-intent surgical treatment, and factors contributing to such variations, for patients with early-stage NSCLC in the United States.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients with stage I or II NSCLC diagnosed in 2007–2014 were identified from 40 states and the District of Colombia population-based cancer registries compiled by the North American Association of Central Cancer Registries. A total of 179,189 patients residing in 2,263 counties were included. Percentage of patients who underwent curative-intent surgery was calculated for each county with 20 or more cases. Adjusted means were generated using mixed effects model accounting for covariates that were significant in three sequential models (model 1: age, sex, race/ethnicity; model 2: race/ethnicity, tumor size, grade; model 3: race/ethnicity, percent below poverty level, urban/rural status, surgeon-to-population ratio). Surgeon-to-population ratio was calculated using the 2010 county-level data from the Area Health Resources Files, by dividing the total number of surgeons (general and thoracic surgeons) by the total population age 35 years and older in the county.

      4c3880bb027f159e801041b1021e88e8 Result

      Receipt of curative-intent surgery for early-stage NSCLC during 2007-2014 by county ranged from 12.8% to 91.7% (sevenfold difference), with a median of 64.5% (interquartile range, 58.8%-71.2%). Higher proportion of non-Hispanic blacks, uninsured patients, and patients residing in high poverty census tracts and in low surgeon-to-population ratio counties were at the lowest quartile of county-level percentage in receipt of curative-intent surgery. In the adjusted means, poverty level, surgeon-to-population ratio, and urban/rural status were independent predictors of receipt of surgery by county. For example, there was a 12% significant difference in adjusted mean between patients residing in affluent and poor neighborhoods.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States. Area-level socioeconomic status and surgeon availability were significantly associated with this variation, which may therefore be amenable to corrective intervention. Further studies are needed to identify and address gaps in access to surgical treatment of early-stage NSCLC.