Lung Cancer

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TU_27_3584 - Quantifying Outcome Disparities in Stage I NSCLC Treated in Urban and Rural Communities

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Quantifying Outcome Disparities in Stage I NSCLC Treated in Urban and Rural Communities
S. M. Dalwadi1, E. Bernicker2, E. B. Butler3, B. S. Teh3, and A. M. Farach3; 1Baylor College of Medicine, Houston, TX, 2Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, 3Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX

Purpose/Objective(s): Key bipartisan legislation recently froze Medicare payment rates for freestanding radiation oncology clinics through 2019 due to the lack of a sustainable alternative payment model. Given that radiation therapy (RT) utilization has steadily increased for stage I NSCLC patients, payment cuts could pose a direct threat to at-risk urban and rural populations. We aim to characterize the existing disparities for stage I NSCLC patients treated in these communities. Materials/Methods: A dataset of 62,213 patients, age 60+, with stage I NSCLC treated from 2004-2012 was retrieved from the SEER database. Patients were divided into metropolitan, urban, or rural (in descending level of population density) based on their location of cancer treatment using the US Rural-Urban Continuum Code Definitions for 2003. Patient characteristics were compared using Chi square and survival statistics were calculated using Kaplan Meier. Results: Rural or urban stage I NSCLC patients are more likely to be white, young, male, poor, uninsured or Medicaid-dependent, and receive RT when compared to metropolitan counterparts (all p<0.0001). Rural and urban patients were more likely to have squamous histology (44%, 42%, and 28% respectively, p<0.0001). Median overall survival was shorter for rural and urban patients than metropolitan patients (41, 41, and 52 months respectively, p<0.0001). For patients receiving RT alone median survival was also shorter for rural and urban patients (26, 23, and 20 months respectively, p<0.0001). Conclusion: Tertiary care centers in metropolitan areas continue to demonstrate superior outcomes presumably due to existing disparities in patient access to care. Rural and urban stage I NSCLC patients (who tend to be younger, poor, and more likely to be treated with RT than surgery) are likely to be disproportionately impacted if a sustainable alternative payment model is not developed to avoid disruption in RT services.
Author Disclosure: S.M. Dalwadi: None. E. Butler: None. B.S. Teh: None. A.M. Farach: None.

Shraddha Dalwadi, MD, MBA, BS

Baylor College of Medicine

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