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E. Taioli
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OA17 - Aspects of Health Policies and Public Health (ID 397)
- Event: WCLC 2016
- Type: Oral Session
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:M. Kneussl
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 1
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OA17.03 - Insurance Type Influences Stage, Treatment, and Survival in Asian American Lung Cancer Patients (ID 5059)
16:20 - 16:30 | Author(s): E. Taioli
- Abstract
- Presentation
Background:
Effect of insurance type on lung cancer diagnosis, treatment and survival is still under debate in Asian patients living in United States.
Methods:
A total of 447,167 patients (18 to 113 years), diagnosed with lung cancer between 2004 and 2013 in the Surveillance, Epidemiology, and End Results database were analyzed. Patient demographics and clinical characteristics were compared between Asian and Non-Asian patients. In Asian patients, patient demographics and characteristics were compared among insurance types. Multivariable logistic regression analysis was performed to identify the effect of insurance types on stage at diagnosis and treatment modalities. Multivariable cox’s regression analysis was performed to identify the effect of insurance type on cancer-specific death.
Results:
Asian were significantly more frequently males (56.7% vs. 53.1%), married (62.2% vs. 50.2%), with Medicaid (17.4% vs. 8.7%), living in rural area (93.6% vs. 86.9%), in a low income county (26.3% vs. 13.4%), and stage 4 at time of diagnosis (51.1% vs. 48.0%) than non-Asian patients (all p-value < 0.001). Among 26,884 Asian lung cancer patients, uninsured were significant younger (61.1±10.8 years) than non-Medicaid (69.1±11.9 years) and Medicaid (70.7±11.7 years), p <0.001, more likely single (18.9 % vs. 8.8% vs. 13.0%); living in a high income county (41.8% vs. 30.5% vs. 38.6%); more likely to be stage IV (63.7% vs. 50.0% vs. 51.2%); and not undergo surgery (86.2% vs. 75.4% vs. 82.6%), [all p-value < 0.001). Localized disease was more frequent in non-Medicaid (21.2%) and Medicaid (17.3%) compared to uninsured (9.0), (p < 0.001).At multivariable analyses, insurance type was not associated with cancer-directed surgery and radiotherapy. Insurance was significantly associated with cancer-specific death (uninsured HR 1.37 95%CI 1.07-1.75; non-Medicaid HR 1.17 95% CI 1.07-1.28 vs Medicaid).Figure 1
Conclusion:
Insurance type affects stage at diagnosis and cancer-specific death but not surgical treatment and radiotherapy in Asian lung cancer patients.
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P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.01-045 - Patient to Hospital Distance in Access to Care and Lung Cancer Surgical Treatment (ID 4464)
14:30 - 14:30 | Author(s): E. Taioli
- Abstract
Background:
Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Health disparties exist in accessing proper care and receving surgical treatment. We examined the role of Patient to Hospital distance (P-H) in access to care.
Methods:
Patients were selected from the New York State Statewide Planning and Research Cooperative System (1995-2012) based on ICD-9-CM diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Distance calculations (ArcMap 10.3.1) and linear regressions (SAS v9.4) were performed to determine the factors influencing P-H.
Results:
There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P; 95% of patients underwent surgery at a hospital < 70 kilometres (km) from their home (mean±SD 20.49±30.24 km; median 11.10 km). P-H was shorter in LR (19.10±27.71 km) than L (21.00±30.96 km) and P (23.87±36.56 km; p < 0.001). At multivariable analysis, P-H was positively associated with teaching hospitals (β: 3.33, p < 0.001), admitted during 1995-2000 (β: 1.08, p < 0.001) and 2001-2006 (β: 1.23, p < 0.001), and P (β: 1.57, p < 0.001), and inversely associated with female gender (β: -0.49, p = 0.016), age at admission (β: -0.17, p < 0.001), black race (β: -8.22, p < 0.001), Medicaid (β: -3.37, p < 0.001), private insurance (β: -0.79, p = 0.004), rural hospitals (β: -2.80, p < 0.001), LR (β -0.81, p < 0.001), and mortality (β -1.05, p = 0.081). Similar associations were found in the L subgroup; among LR patients there was no statistically signficant association between P-H and female gender. Figure 1
Conclusion:
Significant differences exist in P-H and patient/hospital characteristics, which may affect type of surgery and outcome. P-H should be incorporated to improve health disparities in accessing surgical care.
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P2.06 - Poster Session with Presenters Present (ID 467)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Scientific Co-Operation/Research Groups (Clinical Trials in Progress should be submitted in this category)
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.06-045 - Initiative for Early Lung Cancer Research on Treatment (IELCART) (ID 4620)
14:30 - 14:30 | Author(s): E. Taioli
- Abstract
Background:
Randomized controlled trial evidence to guide treatment of early stage lung cancer has been challenging for a variety of reasons. There is now increasing recognition of the power of large databases collected in the context of clinical care to provide important information and there are new statistical techniques for analysis to address unrecognized confounders. We have initiated a new multi-center, international collaborative network for this purpose.
Methods:
Based on an extensive literature review, scientific articles, and a series of focus sessions with a panel of expert surgeons, as well a panel of former patients, a series of critical questions regarding treatment of early lung cancer has been developed. Data forms of relevant data from both physicians and patients pre- and post-surgery to account for potential confounders have been developed, tested, and are being entered into a web-based data collection system that also includes relevant imaging data. Sites are being registered into this new network
Results:
The four primary questions we found needing additional evidence that would be of most concern in regard to treatment of early lung cancer were the following Under what circumstances should limited resection be performed? How large should resection margins be when performing limited resection? When should a watchful waiting approach be considered? When should radiotherapy be considered an option for primary treatment The entire Mount Sinai Health System network which includes 5 hospitals has started enrollment. Treatment is according to usual care but documented in the IELCART registry. Four additional health systems are in the process of joining which requires completing the enrollment application and obtaining IRB approval to submit data to the IELCART registry. Since starting in March 2015, we have enrolled over 30 participants. Actual time required by the surgeon to complete the surgical data prior to surgery is a few minutes. Time to the patient and coordinator to complete the data forms prior to surgery requires between 30 and 60 minutes.
Conclusion:
We anticipate that approximately 10 health care systems will ultimately enroll in the IELCART. Within 2 years, we anticipate starting to have statistically meaningful results in answering the relevant questions. Beyond these, the IELCART registry by continuing to collect data as part of routine clinical practice will provide an important resource to answer future questions in a timely manner as they arise, including performing studies in the neo-adjuvant setting and companion diagnostics.
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P3.07 - Poster Session with Presenters Present (ID 493)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.07-015 - Patterns and Risk Factors of Patient Flows across Different Geographic Health Service Units for Lung Cancer Surgery (ID 5052)
14:30 - 14:30 | Author(s): E. Taioli
- Abstract
Background:
To date lobectomy patient flows across different geographic units and time periods has not been quantified; little is known about associations between hospital- and patient-level factors and travel choices for surgery and the subsequent outcomes. We explored these issues as well as the robustness of the aforementioned associations with changing geographic health service units.
Methods:
The New York Statewide Planning and Research Cooperative System database (2007-2012) was used to select lung cancer patients who underwent lobectomy by Video-Assisted Thoracic Surgery (VATS) or open thoracotomy techniques. Hierarchical logistic regressions were used to examine factors associated with surgeries occurred within or outside of patients’ geographic units: Health Service Regions (HSRs), Health Referral Regions (HRRs), and Health Service Areas (HSAs), respectively.
Results:
A total of 9,655 lobectomies (43% of which were VATS) from 8 HSRs, 21 HRRs, and 145 HSAs were identified. At the state-level, 17%, 22%, and 56% of the lobectomies occurred outside of patients’ HSRs, HRRs, and HSAs, respectively; the percentages varied spatially but the spatial patterns remained stable from 2007 to 2012. Travel-out patients were more likely to be males or with private insurance, and less likely to be non-Hispanics Blacks, Hispanics, or with Medicaid insurance. Travel-out lobectomies were more likely to be performed by VATS, in urban setting, teaching hospitals, with higher lung surgery volume, and higher numbers of surgeons. In-hospital mortality of travel-out lobectomies was not significantly different from that of the stay-in. These associations were consistent among models using different health service geographic units.
Conclusion:
Lung cancer patients tended to travel farther to be treated with VATS in urban/teaching hospitals with high surgery and surgeon volumes. Other independent determinants of the travel choice included sex, insurance type, and race/ethnicity. Patients’ choices and preferences should be taken into account when planning specialized health care delivery services.Figure 1
