Nav: Home

Those living in rural areas, uninsured or on Medicaid less likely to receive recommended lung cancer treatment

March 25, 2020

LOS ANGELES - Lung cancer is the leading cause of cancer-associated deaths in the United States. Non-small cell lung cancer (NSCLC), a group of lung cancers named for the kinds of cells found in the cancer, constitutes more than 80% of all lung cancer cases.

In NSCLC patients where the cancer has spread to one or more lymph nodes close to the lung, a condition known as pathologic N1 (pN1) disease, current guidelines recommend a two-part protocol: the surgical removal of the cancerous tissue (resection) followed by a chemotherapy regimen that contains a cocktail of cancer-fighting drugs.

However, not all pN1 patients are receiving the second part of the protocol.

In a Keck Medicine of USC retrospective study of the National Cancer Database published in The Annals of Thoracic Surgery, of almost 15,000 patients who underwent resection for pN1 disease, only slightly more than half (54.1%) received any chemotherapy. Patients were less likely to receive chemotherapy if they lived in rural areas or were on Medicaid or uninsured.

"This study shows that inequalities exist when it comes to getting the highest level of care," says Elizabeth A. David MD, MAS, a cardiothoracic surgeon with Keck Medicine and the study's lead author. "Previous studies have determined that socioeconomic status plays a role in the surgical management of patients with lung cancer, but we are the first to examine the relationship between socioeconomic status and access to chemotherapy in patients with pN1 disease."

The study also revealed that the benefit of receiving chemotherapy in this patient population is higher than generally thought. Previous research has shown that patients with pN1 disease treated with both surgery and chemotherapy increase their five-year cancer survival rate by 5.4% over those who receive only surgery. David and her colleagues found that the survival rate actually increases by 14% - almost triple the accepted number.

"While this is a significantly greater number than historically reported, due to the breadth of our study, we believe this new statistic is accurate, and we have other studies ongoing to provide more validation," says David, who is also an associate professor of clinical surgery at the Keck School of Medicine of USC.

Researchers collected data on NSCLC patients with pN1 disease from the National Cancer Database, a hospital-based oncology registry sponsored by the American College of Surgeons and the American Cancer Society that captures approximately 70% of all patients with newly diagnosed cancer in the United States.

The study authors examined multiple socioeconomic status variables of the patients -- race/ethnicity, median household income, education level, urban/rural area of residence and insurance status -- to reach their conclusion of a disparity in treatment among those in rural areas or without insurance or on Medicaid. The other socioeconomic categories did not play a role in treatment received.

While it was out of the scope of the study to determine why patients are not receiving chemotherapy, David believes that patients may be offered the treatment, but turn it down. Those in rural areas may have to travel to an urban area far from home to receive surgery and may not have the resources, such as transportation, to commit to follow-up chemotherapy treatments. For those with no insurance or on Medicaid, the cost of the chemotherapy may be a barrier to follow-up treatment.

"It is clear that as medical professionals, we need to find creative solutions to help at-risk populations receive guideline-recommended care," David says. "Lung cancer survival rates are improving and all patients, regardless of where they live or financial status, should be able to take advantage of the treatment that will give them the best chance of recovery and survival."
-end-
The study's other authors include Omar Toubat, medical student; Scott Atay, MD, a thoracic surgeon with Keck Medicine; Anthony Kim, MD, Keck Medicine division chief of thoracic surgery; Li Ding, MD, MPH, a statistician at the Keck School; Albert Farias, PhD, MPH, assistant professor of preventive medicine at the Keck School; Peggy Ebner, medical student; and P. Michael McFadden, MD, a thoracic surgeon with Keck Medicine.

About Keck Medicine of USC

Keck Medicine of USC is one of only two university-based medical systems in the Los Angeles area. Its internationally renowned physicians and scientists provide world-class patient care at Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital and more than 80 outpatient clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties.

Keck Medical Center of USC was ranked No. 16 on U.S. News & World Report's 2019-20 Best Hospitals Honor Roll and among the top 3 hospitals in Los Angeles and top 5 in California. The hospital also ranked in the top 4 in urology (tie); top 10 in geriatrics; top 15 in ophthalmology, cardiology & heart surgery, gastroenterology & GI surgery and nephrology; top 20 in neurology & neurosurgery; top 25 in cancer; and top 35 in pulmonology & lung surgery.

For more information, visit KeckMedicine.org.

University of Southern California - Health Sciences

Related Lung Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Lung transplant patients face elevated lung cancer risk
In an American Journal of Transplantation study, lung cancer risk was increased after lung transplantation, especially in the native (non-transplanted) lung of single lung transplant recipients.
Proposed cancer treatment may boost lung cancer stem cells, study warns
Epigenetic therapies -- targeting enzymes that alter what genes are turned on or off in a cell -- are of growing interest in the cancer field as a way of making a cancer less aggressive or less malignant.
Are you at risk for lung cancer?
This question isn't only for people who've smoked a lot.
Better equipped in the fight against lung cancer
Lung cancer is the third most common type of cancer in Germany and the disease affects both men and women.
New liquid biopsy-based cancer model reveals data on deadly lung cancer
Small cell lung cancer (SCLC) accounts for 14 percent of all lung cancers and is often rapidly resistant to chemotherapy resulting in poor clinical outcomes.
Cancer drug leads to 'drastic decrease' in HIV infection in lung cancer patient
Doctors in France have found the first evidence that a cancer drug may be able to eradicate HIV-infected cells in humans.
Air pollution is associated with cancer mortality beyond lung cancer
A large scale epidemiological study associates some air pollutants with kidney, bladder and colorectal cancer death.
Free lung-cancer screening in the Augusta area finds more than double the cancer rate of previous screenings
The first year of free lung cancer screening in the Augusta, Ga., area found more than double the rate seen in a previous large, national study as well as a Massachusetts-based screening for this No.
More Lung Cancer News and Lung Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#555 Coronavirus
It's everywhere, and it felt disingenuous for us here at Science for the People to avoid it, so here is our episode on Coronavirus. It's ok to give this one a skip if this isn't what you want to listen to right now. Check out the links below for other great podcasts mentioned in the intro. Host Rachelle Saunders gets us up to date on what the Coronavirus is, how it spreads, and what we know and don't know with Dr Jason Kindrachuk, Assistant Professor in the Department of Medical Microbiology and infectious diseases at the University of Manitoba. And...
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.