Author of

• 18749

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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)

  • 18761

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    P3.07-012 - Disparities in Guideline-Concordant Treatment for Node-positive Non-Small Cell Lung Cancer Following Surgery (ID 4382)

    14:30 - 14:30  |  Author(s): B.C. Tong
    • Abstract

    Background:
    To examine guideline concordance across a national sample and to determine the relationship between socioeconomic factors, use of recommended post-operative therapy, and outcomes for patients with pN1 or pN2 non-small cell lung cancer (NSCLC).
    
    Methods:
    All margin-negative pT1-3 N1-2 M0 NSCLC treated with lobectomy or pneumonectomy without induction therapy in the National Cancer Data Base (NCDB) between 2006-2011 were included for analysis. Use of guideline-concordant adjuvant therapy, defined as chemotherapy for pN1 disease and chemoradiation therapy for pN2 disease, were examined regarding pathologic, demographic, and socioeconomic factors. Multivariable regression models were developed to estimate predictors of guideline adherence and outcomes. Survival was estimated using the Kaplan-Meier method.
    
    Results:
    A total of 9,300 patients were identified. Of these, 7,137 had pN1 disease and 2,163 had pN2 disease. Guideline-concordant adjuvant therapy was utilized in 4,477 (62.7%) pN1 patients and 646 (29.9%) pN2 patients. After multivariable adjustment, patient age (OR 0.59 per decade, 95% confidence interval [CI]: 0.56-0.63), uninsured status (OR 0.52, 95%CI:0.39-0.71), N2 disease (OR 0.21, 95%CI:0.18-0.23), pneumonectomy (OR 0.75, 95%CI:0.65-0.86), longer postoperative length of stay (OR 0.96/day, 95%CI:0.95-0.97) and unplanned readmission (OR 0.76, 95%CI:0.61-0.95) were associated with significantly worse guideline concordance, while higher education levels (OR 1.07 per quartile, 95%CI:1.01-1.14) and increasing T-stage (OR 1.08, 95%CI:1.01-1.16) were associated with significantly higher concordance. Overall, patients treated with guideline-concordant therapy had superior survival (5-year survival: 50.4 vs. 35.3%, p<0.001; Figure).Figure 1
    
    
    
    Conclusion:
    Socioeconomic factors, including lack of insurance, are associated with disparities in use of adjuvant therapy as recommended by National Comprehensive Cancer Network guidelines. These disparities have significant impact on patient outcomes. Future work should focus on improving access to appropriate adjuvant therapies among the uninsured and socioeconomically disadvantaged.