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 Researchers reviewed records for more than 200,000 patients who had
lung cancer surgery from 2003 to 2011. They found that while factors
such as age, gender and other medical conditions influenced
survival, so did non-clinical variables like the neighborhoods where
patients lived, and the type of hospital where they were treated.
The researchers had expected that outcomes would be linked with
social and economic factors, said senior author Dr. Felix Fernandez
of Emory University School of Medicine in Atlanta. Their hope now,
he added in an email, is “to focus attention on access and quality
initiatives” in groups at risk for poor outcomes.
Lung cancer is the most common type of malignancy, with about 1.8
million new cases diagnosed a year, according to the World Health
Organization. About 90 percent of cases are caused by smoking,
according to the U.S. Centers for Disease Control and Prevention.
More than half of people diagnosed with lung cancer die within a
year, according to the American Lung Association.
Fernandez and colleagues write in the Journal of the American
College of Surgeons that the gold standard for longer survival is
catching the cancer before it spreads and operating to remove the
diseased tissue. Even then, major complications happen after as many
as one in three surgeries.
The majority of patients in the study were white and around 65 years
old, with roughly equal numbers of men and women.
Most patients didn't have radiation before surgery. A procedure
known as a lobectomy, an operation to remove the lobe of the lung
with diseased tissue, was the most common surgery.
Most patients had Medicare or another government insurance program,
and half of them had a household income of more than $46,000. Most
of them also received treatment at a university hospital or a
comprehensive cancer center.
Patients had poorer odds of surviving 30 days after surgery if they
were older, had other complex medical conditions, or more advanced
tumors.
The likelihood of 30-day survival was also worse if patients lived
outside cities in low-income communities with lower education levels
or if they got treated at non-academic medical centers.
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One limitation of the study is its reliance on a large U.S. cancer
registry, which only covers about 70 percent of cases, the
researchers note. They also relied on 2000 census data for
socioeconomic analysis, which might have overlooked changes in
demographics during the study period.
"Usually, patients coming from low-income communities do not have
the best post-operative surgery treatment not only from the health
system but also from their families," said Dr. Paul Zarogoulidis in
email to Reuters Health. Zarogoulidis is with the pulmonary oncology
unit at Aristotle University of Thessaloniki in Greece.
The study adds to a growing body of research linking lower education
and income levels - as well as poorer access to cancer screening and
other preventive health care - to worse outcomes for patients, Dr.
Christopher Pezzi, director of surgical oncology at Abington
Memorial Hospital in Pennsylvania, said by email.
At the same time, the finding that community hospitals don't get
good outcomes builds on earlier research showing that patients have
better outcomes when both hospitals and surgeons do high volumes of
the procedure, Pezzi said.
For lung cancer, patients should look for hospitals that do at least
30 surgeries a year to remove this type of malignancy, he said.
"The correlation of outcome, specifically 30-day mortality, with
annual hospital volume has been shown repeatedly not just in major
lung cancer resection but in several other major, complex cancer
operations," including procedures for tumors of the pancreas,
esophagus, and bladder, Pezzi said.
"This study adds to the literature exposing disparities in outcomes
for cancer patients based on socioeconomic factors, and also
confirms the well-established relationship of mortality . . . with
annual hospital volume," Pezzi said.
SOURCE: http://bit.ly/1GNwVPO Journal of the American College of
Surgeons, online April 15, 2015.
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