Receipt of Surgery for Early NSCLC Varies by County

There is considerable variation across counties in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC), according to a study published online December in CHEST.

Helmneh M. Sineshaw, M.D., M.P.H., from the American Cancer Society in Atlanta, and colleagues identified 179,189 patients aged ≥35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties. For each county with ≥20 cases, the percentage of patients who underwent surgery was calculated.

The researchers found that during 2007 to 2014, receipt of surgery for early-stage NSCLC varied according to county, from 12.8 to 48.6 percent in the lowest decile of counties and from 74.3 to 91.7 percent in the highest decile of counties. Within each state, there were pockets of low surgery receipt-rate counties. In Massachusetts, there was a 25 percent absolute difference between the lowest and highest surgery receipt-rate counties. Counties with a high proportion of non-Hispanic black individuals, high poverty and uninsured rates, low surgeon-to-population ratios, and nonmetropolitan status were in the lowest quartile for receipt of surgery.

"Area-level socioeconomic and health care delivery factors partially contributed to these variations, suggesting that concerted policy interventions targeting low-access and high-poverty counties may reduce variations in receipt of curative-intent surgery," the authors write.

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