ASO Visual Abstract: Social Vulnerability is Associated with Significant Delays to Definitive Surgery for Stage IA-IIIA Non-small Cell Lung Cancer and Consequential Increased Rates of Pathologic Upstaging.

Timely surgical resection is an important component of treatment for non-small cell lung cancer (NSCLC). The Social Vulnerability Index (SVI) is a validated, composite metric for social determinants of health. This study aimed to determine whether social vulnerability is associated with delayed surgery for NSCLC. The study identified patients with stages IA to IIIA NSCLC who underwent upfront surgery between 2011 and 2021 in a single health care system. High social vulnerability was defined as SVI ≥ 75th percentile. Delayed surgery was defined as longer than 9 weeks after diagnosis. Unadjusted and risk-adjusted predictors of delayed surgery were identified. Time to surgery also was analyzed as a continuous variable. A negative binomial model was fitted to assess the individual impact of social vulnerability on time to surgery in days. Of 595 patients, 120 (20 %) had high social vulnerability. A greater proportion of vulnerable patients experienced surgical delay (32 % vs 16 %; p < 0.001) and had a significantly longer time to surgery (median, 49 days [interquartile range {IQR}, 19-84 days] vs 32 days [IQR, 0-57 days]; p < 0.001). After risk adjustment, high social vulnerability was associated with 2.3 times higher odds of surgical delay (95 % confidence interval [CI], 1.4-3.7), and vulnerable patients waited a risk-adjusted median of 29 days longer for surgery. Surgical delay was significantly associated with pathologic upstaging (43 % vs 23 %; p < 0.001). High social vulnerability is associated with surgical delay in NSCLC, even after controlling for demographic and clinical factors. Delay is subsequently associated with pathologic upstaging. These findings warrant interventions for vulnerable patients to promote equitable surgical care.

Background: Centralization has been advocated for both cystectomy and pneumonectomy, since it has been associated with reductions in mortality. Racial disparities exist for both lung and bladder cancer surgical outcomes despite trends in hospital centralization. We hypothesized that disparities exist in the centralization process for both lung and bladder cancer surgery, and that this has differentially affected surgical outcomes in black and white patients. Methods: The study population was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) database spanning 1997 to 2011, and included 26,750 lung cancer surgeries and 8,168 cystectomies. Hospitals were classified according to procedure volume; patient-hospital distance (PHD) and distance to the nearest high volume / very-high volume (HV/VHV) were calculated. Logistic models were performed to determine factors associated with the utilization of HV/VHV or low volume / very-low volume (LV/VLV) hospitals. Additional models were then performed to assess the association between race and in-hospital mortality, stratified according to whether patients used HV/VHV or LV/VLV hospitals. Results: For cystectomy, PHD increased over the study period while distance to the nearest HV/VHV decreased; for lung cancer surgery, PHD increased but distance to the nearest HV/VHV hospital was constant. For both surgical procedures, black patients experienced increased odds of LV/VLV utilization over time (for lung cancer surgery, ORadj: 1.20; 95%CI [1.01-1.43]; for cystectomy, ORadj: 1.59; 95%CI [1.26-2.02]). When HV/VHV hospitals were located farther from patients, the odds of HV/VHV utilization decreased while the odds of LV/VLV increased for both lung cancer and bladder cancer patients. Lung cancer and bladder cancer in-hospital mortality was higher in blacks (ORadj: 1.50; 95%CI [1.21-1.86]; ORadj: 1.80; 95%CI [1.12-2.90], respectively) compared to whites. Conclusions: Racial differences persisted in hospital utilization and in surgical outcome for both lung and bladder cancers. While proximity and insurance are important determinants of quality care, other personal and community variables not captured by SPARCS are influential in lung and bladder surgical treatment and ultimately outcome. Specific interventions are needed to address accessing and utilizing quality care in underserved populations, including black and low SES patients, and patients with large distances from high-volume hospitals. Citation Format: Wil Lieberman-Cribbin, Martin Casey, Matthew Galsky, Apichat Tantraworasin, Bian Liu, William Oh, Raja Flores, Emanuela Taioli. Effect of centralization on health disparities in lung and bladder cancer surgery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5278. doi:10.1158/1538-7445.AM2017-5278

Evaluating the Optimal Time Between Diagnosis and Surgical Intervention for Early-Stage Lung Cancer

While the impact of demographic factors on postoperative outcomes has been examined, little is known about the intersection between social vulnerability and residential diversity on postoperative outcomes following cancer surgery. Individuals who underwent a lung or colon resection for cancer were identified in the 2016-2017 Medicare database. Data were merged with the Centers for Disease Control and Prevention social vulnerability indexand a residential diversity index was calculated. Logistic regression models were utilized to estimate the probability of postoperative outcomes. Among 55 742 Medicare beneficiaries who underwent lung (39.4%) or colon (60.6%) resection, most were male (46.6%), White (90.2%) and had a mean age of 75.3 years. After adjustment for competing risk factors, both social vulnerability and residential diversity were associated with mortality and other postoperative outcomes. In assessing the intersection of social vulnerability and residential diversity, synergistic effects were noted as patients from counties with low social vulnerability and high residential diversity had the lowest probability of 30-day mortality (3.2%, 95%confidence interval [CI]: 3.0-3.5) while patients from counties with high social vulnerability and low diversity had a higher probability of 30-day postoperative death (5.2%, 95% CI: 4.6-5.8; odds ratio: 1.02, 95%CI: 1.01-1.03). Social vulnerability and residential diversity were independently associated with postoperative outcomes. The intersection of these two social health determinants demonstrated a synergistic effect on the risk of adverse outcomes following lung and colon cancer surgery.

Hospital lung surgery volume and patient outcomes

The volume-outcome relationship in lung cancer surgery: The impact of the social determinants of health care delivery.

Risk and Timing of Venous Thromboembolism After Surgery for Lung Cancer: A Nationwide Cohort Study

Lung cancer is the leading cause of cancer-related deaths worldwide, and its incidence has increased over the past two decades. The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection. Patients with lung cancer presenting with distant metastases belong to stage IV: in this setting, some carefully selected patients may benefit from surgery within a multimodality approach. We performed a comprehensive, non-systematic review of the latest literature to define the present role of surgery in lung cancer treatment. The literature review disclosed a pivotal role of surgery in early stage lung cancer and a complimentary role in locally advanced lung cancer; in very selected cases, surgery might be considered in oligometastatic disease. Surgical treatment of lung cancer still plays a pivotal role in early stages of the disease while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.

Predicting death from surgery for lung cancer: A comparison of two scoring systems in two European countries

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To conduct a population-level analysis of temporal trends and risk factors for high symptom burden in patients receiving surgery for non-small cell lung cancer (NSCLC). A population-level overview of symptoms after curative intent surgery is necessary to inform decision making and supportive care for patients with lung cancer. Retrospective cohort study of patients receiving surgery for stages I to III NSCLC between January 2007 and September 2018. Prospectively collection Edmonton Symptom Assessment System (ESAS) scores, linked to provincial administrative data, were used to describe the prevalence, trajectory, and predictors of moderate-to-severe symptoms in the year following surgery. A total of 5350 patients, with 28,490 unique ESAS assessments, were included in the analysis. Moderate-to-severe tiredness (68%), poor wellbeing (63%), and shortness of breath (60%) were the most common symptoms reported. The rise and fall in the proportion of patients experiencing moderate-to-severe symptoms after surgery coincided with the median time to first (58 days, interquartile range: 47-72) and last cycle of chemotherapy (140 days, interquartile range: 118-168), respectively. There was eventual stabilization, albeit above the preoperative baseline, within 6 to 7 months after surgery. Female sex (relative risk [RR] 1.09- 1.26), lower income (RR 1.08-1.23), stage III disease (RR 1.15-1.43), adjuvant therapy (RR 1.09-1.42), chemotherapy within 2 weeks of an ESAS assessment (RR 1.14-1.73), and pneumonectomy (RR 1.05-1.15) were associated with moderate-to-severe symptoms following surgery. Knowledge of population-level prevalence, trajectory, and predictors of moderate-to-severe symptoms after surgery for NSCLC can be used to facilitate shared decision making and improve symptom management throughout the course of illness.

Objective To analyze the clinical efficacy of neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer (NSCLC). Methods From March 2008 to October 2015, there were 92 cases of stage ⅢA NSCLC patients received 2 cycles of neoadjuvant chemotherapy and underwent radical surgery for lung cancer 3-4 weeks late (observation group), and another group of 65 cases of stage ⅢA NSCLC patients (control group) underwent surgery for lung cancer without preoperative chemotherapy. The clinical data as well as early and meddle term surgical outcome of both groups were analyzed retrospectively. Results The neoadjuvant chemotherapy effective rate was 73.9% in the observation group. All surgeries for lung cancer patients were undertaken either with video-assisted thoracotomy or traditional thoracotomy. No operative mortality and the postoperative pathology findings were in accordance with NSCLC. The bleeding amount and operation time of two groups were similar; the resection rate of the observation group was greater than that of the control group. All patients were followed up at least 3 years, and the 2 years and 3 years survival rate of the observation group was slightly higher than that of the control group. Conclusions Preoperative neoadjuvant chemotherapy in patients with NSCLC can improve the resection rate and prolong the survival time, which is worthy of clinical application. Key words: Chemotherapy, adjuvant; Carcinoma, non-small-cell lung/TH

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Integration of palliative care services into the surgical treatment plan is important for holistic patient care. We soughtto examine the association between patient race/ethnicity and county-level vulnerability relative to patterns of hospice utilization. Medicare Standard Analytic Files were used to identify patients undergoing lung, esophageal, pancreatic, colon, or rectal cancer surgery between 2013 and 2017. Data were merged with the Centers for Disease Control and Prevention's social vulnerability index (SVI). Logistic regression was utilized to identify factors associated with overall hospice utilization among deceased individuals. A total of 54,256 Medicare beneficiaries underwent lung (n = 16,645, 30.7%), esophageal (n = 1427, 2.6%), pancreatic (n = 6183, 11.4%), colon (n = 26,827, 49.4%), or rectal (n = 3174, 5.9%) cancer resection. Median patient age was 76years (IQR 71-82years), and 28,887 patients (53.2%) were male; the majority of individuals were White (91.1%, n = 49,443), while a smaller subset was Black or Latino (racial/ethnic minority: n = 4813, 8.9%). Overall, 35,416 (65.3%) patients utilized hospice services prior to death. Median SVI was 52.8 [interquartile range (IQR) 30.3-71.2]. White patients were more likely to utilize hospice carecompared with minority patients (OR 1.24, 95% CI 1.17-1.31, p < 0.001). Unlike White patients, there was reduced odds of hospice utilization (OR 0.97, 95% CI 0.96-0.99) and early hospice initiation (OR 0.94, 95% CI 0.91-0.97) as SVI increased among minority patients. Patients residing in counties with high social vulnerability were less likely to be enrolled in hospice care at the time of death, as well as be less likely to initiate hospice care early. The effects of increasing social vulnerability on hospice utilizationwere more profound among minority patients.

It has been suggested that lung cancer follows a more aggressive course and has a poorer prognosis in young patients than in elderly patients. We conducted this study to determine whether the basal characteristics and survival of young patients undergoing surgical resection of lung cancer differ from those of elderly patients. Eighty patients who underwent surgery for lung cancer at our hospital between 1989 and 2004 were divided into two groups according to age. Group 1 comprised 50 patients aged 45 years or younger and group 2 comprised 30 patients aged 70 years or older. The patients' medical records were reviewed with respect to age, gender, histological diagnosis, coexisting diseases, smoking history, postoperative staging, type of operation, and postoperative morbidity, mortality, and survival results. The average ages were 40.2 +/- 3.77 years (range, 29-45 years) in group 1 and 72.2 +/- 2.53 years (range, 70-80 years) in group 2. The incidence of postoperative complications was significantly higher in group 2 (P = 0.02). However, the 5-year survival rates for patients who underwent surgery for non-small cell lung cancer did not differ between groups 1 and 2, at 33.3% versus 21.3%, respectively (P = 0.09). The incidence of adenocarcinoma was higher in the young patients, whose prognosis was slightly better than that of the elderly patients. Coexisting diseases and postoperative complications were the major factors that adversely affected the prognosis of the elderly patients.