Outcomes among patients with a history of substance abuse in non-small cell lung cancer: A county hospital experience.

Abstract

e20031 Background: Insufficient outpatient care among vulnerable patients, such as those with a history of alcohol or illicit substance use disorder (SUD), may contribute to poor outcomes in non-small cell lung cancer (NSCLC). We hypothesize that patients with newly diagnosed localized NSCLC and a history of SUD have a shorter time from diagnosis to last known contact, greater rates of depression, less family support, poorer follow-up, and increased emergency room and inpatient usage compared to those without a history of SUD. Methods: To investigate this, we conducted a retrospective review of all lung cancer patients with localized non-small cell carcinoma (N = 52) with visits between 9/2012 and 9/2018 at an academic county hospital with a dedication to the underserved in a major US city. Data were collected from electronic medical records manually and analyzed using ANOVA for continuous variables or Pearson's Chi-squared for categorical data. Results: Among patients with localized NSCLC (n = 52), 44% had a history of SUD. The mean time from diagnosis to last known contact and rate of loss-to-follow-up among those with a history of SUD vs no history of SUD was: 2.9 vs 4.4 years (p = 0.14) and 26.1% vs 20.7% (p = 0.64) respectively. Patients with history of SUD were more likely to live without family members and have a history of depression, anxiety or PTSD than those without a SUD history; 78.3% vs 44.8% (p = 0.023) and 60.9% vs 20.7% (p = 0.004). In the year following diagnosis the mean percentage of missed appointments, number of ER visits, number of inpatient stays, and total length of inpatient stay for patients with history of SUD vs no history of SUD were: 19% vs 8% (p = 0.01), 3.7 vs 1.4 (p = 0.08), 2.6 vs 0.9 (p = 0.10), and 17.7 vs 5.9 days (p = 0.06) respectively. Conclusions: In this retrospective analysis of patients with localized NSCLC, those with a history of SUD had shorter time from diagnosis to last known contact without increased rates of loss-to-follow-up. They also had greater rates of depression, less family support, increased rates of missed appointments, more emergency room visits, increased hospitalizations, and increased total duration of inpatient stay in the year following their diagnosis.