Disparities in first-course treatment of non-small cell lung cancer among different hospital types in the United States.

Abstract

6568 Background: Treatment of non-small cell lung cancer (NSCLC) involves surgery, chemotherapy and radiation therapy in various combinations depending upon stage. This study compares disparities in the 1st course treatment given to NSCLC patients amongst different hospital types. Methods: We analyzed National Cancer Data Base for differences in 1st course treatment received for NSCLC amongst 3 hospital categories- Community hospitals (facilities which diagnose and/or treat 100-649 cancer cases annually), Comprehensive Community Hospitals (facilities which diagnose and/or treat 650 or more) and Teaching/Research Hospitals (facilities associated with university medical schools or designated as Comprehensive Cancer Care Programs by National Cancer Institute). Chi square test was used for statistical analysis. Results: 975,229 patients with NSCLC received treatment in 1,399 U.S. hospitals between 2000 and 2010. 71%, 81% and 84% of patients presenting to Community, Comprehensive and Teaching/Research hospitals received 1st course treatment at those centers. Surgery was done in 64%, 77% and 81% of stage I; 52%, 62% and 71% of stage II and 16%, 20% and 27% of stage III patients treated by Community, Comprehensive and Teaching/Research hospitals respectively (p<0.001 for all comparisons) (Table). Also, chemotherapy was given as a part of 1st course treatment in 37%, 30% and 22% of stage II patients treated by these hospitals respectively (p<0.001 for all comparisons). Conclusions: Significant disparities exist in treatment of NSCLC amongst different hospital types. Patients treated at research/teaching hospitals hospital are more likely to receive surgery as 1st line compared to Community and Comprehensive hospital for stage I to III NSCLC. [Table: see text]