Examining patient burden and drivers of delayed care in patients undergoing surgical treatment of primary lung cancer.

Abstract

153 Background: Patients’ geographic location can impact access to specialty care and affect the appropriateness and timeliness of evaluation leading to primary surgical treatment of lung cancer. Cancer care coordination has long been speculated to lead to greater efficiency in oncologic care, yet objective measures demonstrating the utility of such healthcare team members is lacking. We aimed to study the impact of patients’ residence on healthcare encounters, travel burden and the distribution of physiologic and oncologic workup leading to delays in care at a specialty cancer center. Methods: We conducted a single center retrospective cohort study of 103 patients undergoing workup of primary lung cancer between January 2015 and August 2017. The shortest route between patient residence and treating medical center was measured in miles and classified as: urban ( < 40 miles); rural (40.1 – 100 miles); and regional (100.1 – 1,000 miles). Average total miles traveled (i.e. travel burden), total number of healthcare encounters, and the distribution of physiologic and oncologic evaluations as drivers of delay in care were examined. Results: Patients were categorized as urban n = 80 (77.7%); rural n = 12 (11.7%); and regional n = 11 (10.7%). Median travel burden (urban = 100 miles [interquartile range, IQR 56-216.8]; rural = 385.7 [127.1 – 769]; regional = 780 [560 – 1936]; p < 0.001) and median total healthcare encounters (urban = 7 [6-9]; rural = 9 [7-9.5]; regional = 10 [7-12]; p = 0.3) increased with greater distance of patient residence from treating medical center. Additional necessary physiologic workup was associated with delayed care and greater burden in the rural and regional patients compared to those residing in urban locations (urban = 21% increase; rural = 152%; regional = 162%). Additional oncologic workup was associated with delayed care in the regional group only (49% increase). These trends remained even when controlling for clinical stage. Conclusions: These findings demonstrate the need for better cancer care coordination for rural and regional lung cancer patients to improve efficiency, appropriateness and timeliness of care while decreasing patient-related burdens.