TY - JOUR
T1 - Impact of travel distance on receipt of indicated adjuvant therapy in resected non–small cell lung cancer
AU - Eisenberg, Michael A.
AU - Deboever, Nathaniel
AU - Mills, Alexander C.
AU - Egyud, Matthew R.
AU - Hofstetter, Wayne L.
AU - Mehran, Reza J.
AU - Rice, David C.
AU - Rajaram, Ravi
AU - Sepesi, Boris
AU - Swisher, Stephen G.
AU - Walsh, Garrett L.
AU - Vaporciyan, Ara A.
AU - Antonoff, Mara B.
N1 - Publisher Copyright:
© 2023 The American Association for Thoracic Surgery
PY - 2024/5
Y1 - 2024/5
N2 - Objective: We have previously demonstrated the negative impact of travel distance on adherence to surveillance imaging guidelines for resected non–small cell lung cancer (NSCLC). The influence of patient residential location on adherence to recommended postoperative treatment plans remains unclear. We sought to characterize the impact of travel distance on receipt of indicated adjuvant therapy in resected NSCLC. Methods: We performed a single-institution, retrospective review of patients with stage II-III NSCLC who underwent upfront pulmonary resection, 2012-2016. Clinicopathologic and operative/perioperative details of treatment were collected. Travel distance was measured from patients' homes to the operative hospital. Our primary outcome was receipt of adjuvant systemic or radiotherapy. Travel distance was stratified as <100 or >100 miles. Multivariable logistic regression was performed. Results: In total, 391 patients met inclusion criteria, with mean age of 65.9 years and fairly even sex distribution (182 women, 49.2%). Most patients were Non-Hispanic White (n = 309, 83.5%), and most frequent clinical stage was II (n = 254, 64.9%). Indicated adjuvant therapy was received by 266 (71.9%), and median distance traveled was 209 miles (interquartile range, 50.7-617). Multivariate analysis revealed that longer travel distance was inversely associated with receipt of indicated adjuvant therapy (odds ratio, 0.13; 95% confidence interval, 0.06-0.26; P < .001). In addition, Black patients were less likely to receive appropriate treatment (odds ratio, 0.05; 95% confidence interval, 0.02-0.15; P < .001). Conclusions: Travel distance >100 miles negatively impacts the likelihood of receiving indicated adjuvant therapy in NSCLC. Indications for systemic therapy in earlier staged disease are rapidly expanding, and these findings bear heightened relevance as we aim to provide equitable access to all patients.
AB - Objective: We have previously demonstrated the negative impact of travel distance on adherence to surveillance imaging guidelines for resected non–small cell lung cancer (NSCLC). The influence of patient residential location on adherence to recommended postoperative treatment plans remains unclear. We sought to characterize the impact of travel distance on receipt of indicated adjuvant therapy in resected NSCLC. Methods: We performed a single-institution, retrospective review of patients with stage II-III NSCLC who underwent upfront pulmonary resection, 2012-2016. Clinicopathologic and operative/perioperative details of treatment were collected. Travel distance was measured from patients' homes to the operative hospital. Our primary outcome was receipt of adjuvant systemic or radiotherapy. Travel distance was stratified as <100 or >100 miles. Multivariable logistic regression was performed. Results: In total, 391 patients met inclusion criteria, with mean age of 65.9 years and fairly even sex distribution (182 women, 49.2%). Most patients were Non-Hispanic White (n = 309, 83.5%), and most frequent clinical stage was II (n = 254, 64.9%). Indicated adjuvant therapy was received by 266 (71.9%), and median distance traveled was 209 miles (interquartile range, 50.7-617). Multivariate analysis revealed that longer travel distance was inversely associated with receipt of indicated adjuvant therapy (odds ratio, 0.13; 95% confidence interval, 0.06-0.26; P < .001). In addition, Black patients were less likely to receive appropriate treatment (odds ratio, 0.05; 95% confidence interval, 0.02-0.15; P < .001). Conclusions: Travel distance >100 miles negatively impacts the likelihood of receiving indicated adjuvant therapy in NSCLC. Indications for systemic therapy in earlier staged disease are rapidly expanding, and these findings bear heightened relevance as we aim to provide equitable access to all patients.
KW - adjuvant therapy
KW - disparities
KW - non–small cell lung cancer
KW - pulmonary resection
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U2 - 10.1016/j.jtcvs.2023.08.049
DO - 10.1016/j.jtcvs.2023.08.049
M3 - Article
C2 - 37696428
AN - SCOPUS:85173711018
SN - 0022-5223
VL - 167
SP - 1617
EP - 1627
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -