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Socioeconomic factors affected resection type in NSCLC patients
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Researchers have identified certain clinical, socioeconomic and surgeon characteristics that are associated with a decreased likelihood of patients with non–small cell lung cancer undergoing lobectomy.
Although lobectomy is considered to be the standard treatment for patients with early stage NSCLC, prior research has shown that patients are still commonly undergoing limited resections, which may increase a patient’s likelihood for local recurrence.
In this study, researchers sought to identify what patient factors and surgeon factors might be associated with the likelihood of undergoing a lobectomy vs. a limited resection.
They took data from a population-based and health system-based sample of patients with newly diagnosed stage I or stage II NSCLC between 2003 and 2005. Patients were observed for an average of 55 months. Postoperative and long-term outcomes were also examined.
During the study period, 23% of patients underwent limited resection vs. 77% who underwent lobectomy. Data indicated that the adjusted 30-day mortality was no different between patients who underwent lobectomy vs. limited resection, and that postoperative complications were also similar between the two groups.
Tumor size (P=.004), coverage under Medicare or Medicaid, having no insurance or unknown insurance (P=.02), having more severe lung disease (P<.001) and a history of stroke (P=.05) were all associated with a patient undergoing limited resection of the NSCLC.
When examining surgeon characteristics, researchers found that being a thoracic surgery specialist (P=.02), non-fee-for-service compensation (P=.008), and NCI cancer center designation (P=.006) were also associated with higher likelihood of a patient undergoing limited resection.
“Providers should seek to reduce the impact of socioeconomic factors such as patient insurance status and surgeon compensation type on clinical decision making,” the researchers said.
For more information:
- Billmeier SE. J Natl Cancer Inst. 2011;103:1-9.