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Sendilnathan Ramalingam

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    OA11 - Decomplexifying Molecular Targets, Immunotherapy and Treatment Settings in the Real World (ID 137)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      OA11.03 - Survival Disparities Between Academic and Community Centers in Advanced Lung Cancer in the US: Can We Bridge the Gap? (Now Available) (ID 1731)

      14:00 - 15:30  |  Presenting Author(s): Sendilnathan Ramalingam

      • Abstract
      • Presentation
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      Lung cancer causes the most cancer deaths in the US. Our prior study found widening 2-year survival (2YS) disparity between academic and community-based centers (ACs and CCs) prior to 2010, most apparent in adenocarcinoma, suggesting a treatment-related effect. We hypothesized this disparity continued to widen in more recent years.


      Retrospective study of outcomes through 2015 within the National Cancer Database. The primary outcome was 2YS. We used multivariable regression modeling, incorporating diagnosis year, facility type, age, gender, Charlson-Deyo score, and histology to compare AC/CC. A third facility type was identified, Integrated Network Cancer Programs (IC); we did a separate analysis incorporating AC/CC/IC. We formed six cohorts by 1)facility type and 2)time period (2004 through 2008, and 2011 through 2015). Hazard ratios were computed to compare survival between these six cohorts.


      98,069 patients were included. Treatment in ACs had superior 2YS compared to treatment in CCs, increasing from 16.1% versus 10.3% for those diagnosed in 2004(+5.8%), to 23.7% versus 16.2% for those diagnosed in 2013(+7.5%). Our multivariable model found growth in 2YS disparity of 0.34%-per-year (95% CI 0.18% to 0.50%, p<0.001). This was histology-related: Difference in adenocarcinoma 2YS rose from 7% in 2004 to 9% in 2013(p=0.0023), while squamous carcinoma 2YS difference was 2.7% in 2004 and 0.8% in 2013(p=0.6). 9047 patients were treated at ICs. In the 2004-2008 cohort treatment at ICs had similar outcomes to CCs, however by 2011-2015 ICs had superior histology-related survival, suggesting treatment-related improvements in ICs over CCs (Table 1).


      Survival disparities in metastatic lung cancer between academic and community-based centers in the US continued to widen through 2015. Treatment at integrated centers, a group of facilities with at least one hospital that can include community and academic centers, may help to bridge the divide. Treatment related disparities in other health systems warrant further study globally.

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