Disparities in Access to Multidisciplinary Cancer Consultations and Treatment for Patients With Early-Stage Non-Small Cell Lung Cancer: A SEER-Medicare Analysis

Abstract

PurposeDisparities in access to multidisciplinary cancer consultations (MDCc) persist, and the role of physician relationships remains understudied. This study examined the extent to which multilevel factors, including patient characteristics and patient-sharing network measures reflecting the structure of physician relationships, are associated with MDCc and receipt of stereotactic body radiation therapy (SBRT) versus surgery among early-stage non-small cell lung cancer (NSCLC) patients. Materials and MethodsIn this cross-sectional study, we analyzed Surveillance, Epidemiology, and End-Result (SEER)-Medicare data for patients diagnosed with stage I-IIA NSCLC in 2016-2017. We assembled patient-sharing networks and identified cancer specialists who were locally unique for their specialty, herein referred to as “linchpins”. The proportion of linchpin cancer specialists for each hospital referral region (HRR) was calculated as a network-based measure of specialist scarcity. We used multilevel multinomial logistic regression to estimate associations between study variables and the receipt of MDCc and multilevel logistic regression to examine the relationship between MDCc and patient's first treatment. ResultsOur study included 6,120 patients with stage I-IIA NSCLC, of which 751 (12.3%) received MDCc, 1,729 (28.3%) only consulted a radiation oncologist, 2,010 (32.8%) only consulted a surgeon, and 1,630 (26.6%) had no consultations with either specialist within two months following diagnosis. Compared with patients residing in an HRR with a low proportion of linchpin surgeons, those in an HRR with a high proportion of linchpin surgeons had a 2.99 (95% CI: 1.87-4.78) greater relative risk of exclusively consulting a radiation oncologist (vs. MDCc) and a 2.70 (95% CI: 1.68-4.35) greater relative risk consulting neither specialist (vs. MDCc). Patients who received MDCc were 5.32 (95% CI: 4.27-6.63) times more likely to receive SBRT (vs. surgery). ConclusionsPhysician networks are associated with receipt of MDCc and treatment, underscoring the potential for leveraging patient-sharing network analysis to improve access to lung cancer care.