Rural healthcare: A retrospective review of lung carcinoma demographics and screening in the northern Arizona healthcare system.

Abstract

e18696 Background: In the United States, lung carcinoma is the leading cause of cancer mortality. In 2022, the National Cancer Institute estimated 236,740 new cases of lung cancer, or 12.3% of all new cancer cases, and 130,180 deaths, or 21.4% of all cancer deaths. The risk factors for lung cancer include cigarette smoking, secondhand smoke, the non-Hispanic population, air pollution, or prior radiation therapy. The fatality and common risk factors emphasize the importance of the screening guidelines. Northern Arizona is considered an area affected by downwinder syndrome which is defined as individuals exposed to radiation from the explosion of nuclear devices at the Federal Nevada Test Site with radioactive materials being disturbed by winds. Northern Arizona Healthcare (NAH) has a large population located in these affected counties and lung cancer demographics were reviewed to observe for any variation when compared to the general population. The patients were also reviewed to determine if there were any major deficits in screening guidelines. Methods: This retrospective review included patients diagnosed with lung carcinoma based on the ICD 9 and 10 codes between 2015 to 2020 in the NAH systems. The total number of charts included 559 but 184 were excluded for the following reasons: concern for lung cancer, but not confirmed, patients located not in Northern Arizona, diagnosed prior to 2015, duplicate name but same medical record number, malignancy other than lung cancer, metastatic cancer with unknown primary, and lung cancer was eventually ruled out. The total number of patients remaining in the review was 375. Demographics and lung carcinoma screening information were obtained through NAH medical records. Results: Demographics: median age of 71 with 286 of 375 patients > 65; gender 53.06% males, 46.4% female; race: 88.8% Caucasian, 4.8% Hispanic, Native American 4%, African American 2.1%, Asian 0.3%; smoking history 56.8% active, 31.4% former, 10.6% never; Lung Cancer Pathology: Adenocarcinoma 49.3%, Squamous Cell 18.9%, NSCLC (other than adenocarcinoma or squamous cell) 11.78%, Small Cell 17%, undetermined 2.7%; Lung Cancer Screening: 64.50% no screening vs 7.2% who did, 28.3% were indeterminable. Conclusions: Despite Northern Arizona being considered an area affected by downwinder syndrome, a five-year review of lung carcinoma demographics did not expose any major variation when compared to the generalized population. A limitation was molecular markers were not included and a potential area of further investigation. The review did expose deficits in lung carcinoma screening. 64% of the 375 patients were not screened for lung cancer. A formal presentation was held at NAH grand rounds to raise awareness of lung carcinoma screening guidelines. For future advancement, a collaboration with IT to develop outpatient screening alerts to optimize healthcare in rural areas.