249651 Safety-Net Burden and Likelihood of Curative-Intent Surgery for Non-Small Cell Lung Cancer

Monday, October 31, 2011: 11:06 AM

Katherine S. Virgo, PhD, MBA , Managing Director, Health Services Research/ Intramural Research, American Cancer Society National Home Office, Atlanta, GA
Alex Little, MD , Department of Surgery, University of Arizona, Tucson, AZ
Stacey Fedewa, MPH , Health Services Research/Intramural Research, American Cancer Society National Home Office, Atlanta, GA
Amy Chen, MD, MPH , Health Services Research/Intramural Research, American Cancer Society & Emory University, Atlanta, GA
W. Dana Flanders, MD , Department of Epidemiology, Emory University, Atlanta, GA
Elizabeth M. Ward, PhD , Intramural Research, American Cancer Society National Home Office, Atlanta, GA
Background: Black patients are less likely to undergo surgery for early-stage non-small cell lung cancer (NSCLC) compared to whites and are more likely to undergo resection at low-volume hospitals. However, little is known about the relationship between hospital safety-net burden and the likelihood of curative-intent surgery for blacks and whites. This study analyzes whether hospital safety-net burden is associated with curative-intent surgery among all adult early-stage NSCLC patients treated at American College of Surgeons (ACoS) Commission on Cancer (CoC) accredited facilities. Study Design: Adult patients diagnosed with invasive initial primary early-stage (TNM I-II) NSCLC during 2003-2005 were selected from the National Cancer Data Base (NCDB). Curative-intent surgery was defined as anatomic resection. Hospital safety-net burden was defined as the percent of cancer patients per facility that were Medicaid-insured or uninsured. Generalized estimating equations and linear mixed models were used to control for clustering by facility. Results: Of 52,853 evaluable patients, patients treated at high safety-net burden facilities were significantly less likely (p < .0001) to undergo curative-intent surgery than patients treated at low safety-net burden facilities (57.2% and 66.0%, respectively). Controlling for patient and other facility characteristics, high safety-net burden remained significantly associated (p < .0001) with reduced likelihood of curative-intent surgery overall (OR=0.72, C.I. 0.650.79), and in black- and white-only models (OR=0.64, C.I. 0.520.77; OR = 0.74, C.I. 0.670.82, respectively). Conclusions: Both black and white adult patients treated for early-stage NSCLC at high safety-net burden facilities are less likely to undergo curative-intent surgery than those treated at low safety-net burden facilities. Innovative solutions are needed to ensure quality cancer care at high safety-net burden facilities.

Learning Areas:
Provision of health care to the public

Learning Objectives:
Identify hospital characteristics that serve as a barrier to patients receiving curative-intent surgery for non-small cell lung cancer. Compare by race the likelihood of accessing curative-intent surgery for non-small cell lung cancer at safety-net burden facilities.

Keywords: Barriers to Care, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: of my experience in the analysis of large databases and my previous work in the lung cancer field.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.