Disparities Found in Lung Cancer Care Between Academic, Community Centers

As novel treatment strategies for non-small cell lung cancer (NSCLC) emerge, therapeutic approaches have shifted toward a focus on targeted therapies. With the new advancements in cancer treatment, there is a concern of disparities in care between patients treated in academic centers (ACs) and community centers (CCs).

A study published in the Journal of Thoracic Oncology and led by Duke University researchers evaluated whether treatment at ACs was associated with improved survival in patients with metastatic NSCLC, given their access to resources and specialists that CCs may not have.

Using data from 1998 to 2012, the researchers investigated the 2-year survival rate for patients, controlling for age, year of diagnosis, gender, primary payer, histology, and facility type.

The study included data from 193,279 patients with clinical or pathological metastatic NSCLC. Overall, the researchers found a greater increase in survival in those treated in ACs compared with CCs. In 1998, 2-year survival in ACs was 11.5% versus 9.2% in CCs, increasing to 17.4% versus 13.3%, respectively, by 2010. Other factors associated with higher 2-year survival included being female, later diagnosis year, lower age, and having insurance (with the exception of Medicaid), according to the researchers.

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The study also revealed an overall histology-dependent survival difference in adenocarcinoma versus squamous cell carcinoma. Adenocarcinoma survival varied by treatment facility, where the difference in 2-year survival in ACs versus CCs increased from 12.3% versus 9.1% in 1998 to 20.5% versus 15.5% in 2010. Within the adenocarcinoma group, the results showed a 1.8% per decade increase in 2-year survival in ACs versus CCs, which was not seen in squamous cell carcinoma.

The researchers noted that ACs may have more availability of lung cancer specific pathologists and molecular testing to manage the growing complexity of metastatic NSCLC systemic therapies, which may have driven disparities in care. With the more recent introduction of additional novel treatments, they suggested that additional study is needed to determine if the trend has continued.

“To reduce disparity in patient outcomes, strategies to accelerate these advances in community centers may be needed,” the researchers wrote.

References

Ramalingam S, Dinan MA, Crawford J. Survival comparison in patients with stage IV lung cancer in Academic versus Community Centers in the United States. Journal of Thoracic Oncology. 2018. Doi: https://doi.org/10.1016/j.jtho.2018.09.007.

Increased survival in patients with metastatic NSCLC receiving treatment in academic centers [news release]. International Association for the Study of Lung Cancer’s website. https://www.iaslc.org/news/increased-survival-patients-metastatic-nsclc-receiving-treatment-academic-centers. Accessed October 11, 2018.