A Comparison of Overall Patient Reported Distress Levels in Appalachian Cancer Patients From Economically Distressed vs. Non-Economically Distressed Counties Receiving Radiation Therapy for Thoracic Malignancies

Abstract

<h3>Purpose/Objective(s)</h3> Appalachia has historically been an impoverished region. Higher levels of poverty are positively correlated with poorer cancer outcomes, particularly with areas that had a strong coal mining industry. Our medical center primarily serves 21 counties located entirely within Appalachian, 11 of which are economically classified as having a "Distressed" or "At Risk" by the Appalachian Regional Commission (ARC). The patients traveling from these counties usually have longer commute times and reliable access to care can be challenging. The remaining 10 counties are deemed "Transitional" and no county is designated in ARC's economically successful "Competitive" or "Attainment" categories. Considering the correlation between poverty level and outcomes, we hypothesized that patients from the "Distressed" or "At Risk" counties would have higher overall distress levels compared to "Transitional" counties. <h3>Materials/Methods</h3> Of 479 patients receiving radiotherapy (RT) at our institution for lung cancer in 2019 and 2020, 79 sequential patients treated with RT without definitive surgery were identified who had their overall distress level prospectively measured using the NCCN distress instrument prior to starting RT. Patient demographics, tumor and treatment characteristics, and overall distress data were collected and mean values of distress between groups were assessed using Pearson's chi-squared test. <h3>Results</h3> There were no statistically significant differences in patient, tumor, or treatment characteristics between distressed and non-distressed counties, with the exception of cancer stage. 84% of patients coming from distressed counties had Stage I lung cancers (p=0.04). Patients coming from economically "At Risk'' and "Distressed" counties had a median distress score of 2.8 (range 0 to 9); patients from "Transitional" counties had a median distress score of 3.3 (p-value = 0.5). <h3>Conclusion</h3> Our study did not find a statistically significant difference in overall distress levels between patients coming from areas of economic hardship. We hypothesize that a lung cancer diagnosis is one of many stressors facing our Appalachian patients coming from economically distressed regions. Additionally, the majority of patients referred for radiotherapy had Stage I cancers that were asymptomatic. Lung and heart diseases are also more prevalent in these poorer counties and may lead to an earlier subsequent diagnosis of lung cancer incidentally at an earlier age in some patients, which may in turn also result in a better cancer prognosis and prevent distress in the population we studied.