Neighborhood disparities in timeliness of treatment for early stage lung cancer patients.

Abstract

e19017 Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the United States, accounting for approximately 25% of all cancer deaths. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. Neighborhoods are key determinants of health and the neighborhood social and built environments can influence cancer treatment and outcomes. Minority segregated neighborhoods often have limited health resource availability. The objective of this study is to estimate the relationship between neighborhood segregation on racial and ethnic disparities in timely receipt of GCT in early-stage lung cancer patients in California. Methods: We studied 22,903 patients diagnosed with stage I/II non-small cell lung cancer (2006-2015) in the California Cancer Registry. The primary outcome of the study is receipt of GCT according to the 2016 NCCN guidelines defined as the administration of proper initial and adjuvant treatment(s) according to cancer site and stage, and measured using surgery type, chemotherapy type, and radiation type. The secondary outcome was timely receipt of care as defined as the initiation of surgery, radiation, or chemotherapy within 45 days of diagnosis for initial treatment and the initiation of chemotherapy +/- radiation within 6 months of initial surgery for N1 patients for adjuvant treatment. Multivariable hierarchical logistic regression will be used to estimate the effect of neighborhood segregation on timely receipt of GCT, adjusting for individual- and neighborhood-level covariates, and stratified by patient race/ethnicity. Results: Overall, 81.39% of patients received GCT; 57.63% of them within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We hypothesize that increased neighborhood segregation will decrease a patient’s likelihood of adherence to GCT and timely GCT. Conclusions: This research is vital to improving our understanding of cancer-related health disparities and promoting health in vulnerable neighborhoods. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment is critical.