Minerva Eleonora Maddalena, Tessitore Adele, Cafarotti Stefano, Patella Miriam
Thoracic Surgery Department, Ospedale Regionale di Bellinzona e Valli, Via Ospedale, Bellinzona, Switzerland.
Front Surg. 2022 Apr 28;9:884048. doi: 10.3389/fsurg.2022.884048. eCollection 2022.
Rural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic-surgical pathway and urban-rural residency in our region.
We retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017-2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural-urban residency classification from the Department of Land.
A total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [(3, 270), < .05, = 0.24]: rurality ( = 0.04), GP involvement ( = 0.04), and presence of lung cancer-related symptoms ( = 0.02).
In our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program.
大国的农村人口在肺癌诊断和治疗方面往往会延迟或效果欠佳。差异与基于人群的因素有关，如人均收入较低或风险因素增加，或与获得医疗设施的差异有关。瑞士是一个小国，富裕且具有独特的地理和城市特征。我们探讨了本地区肺癌诊断-手术路径与城乡居住地之间的关系。
我们回顾性分析了在本机构接受原发性非小细胞肺癌治疗的280例连续患者的病历（2017 - 2021年）。这是一个地区性三级诊断和治疗中心，数据从前瞻性收集的临床数据库中提取。我们纳入了肺解剖切除术。收集的变量包括患者和手术特征、风险因素、合并症、组织学和分期、症状（与偶然诊断相比）、全科医生（GP）参与情况、健康保险以及疑似检查-治疗间隔。暴露因素为农村地区，根据土地部门2009年的城乡居住分类来定义。
共有150例患者（54%）居住在农村地区。农村患者吸烟史的比例更高（93%对82%；P = 0.007）。有症状诊断与偶然诊断、既往癌症发生率、保险情况和病理分期方面没有差异。农村患者的合并症负担更重（农村人群调整年龄后的平均查尔森合并症指数为5.3，城市人群为4.8，P = 0.05），并且全科医生在诊断路径中的参与度更高（51%对39%，P = 0.04）。首次疑似检查与治疗之间的间隔明显更短（56天对66.5天，P = 0.03）。进行了向后逐步淘汰的多元线性回归分析。这些变量在统计学上预测了从首次疑似检查到手术治疗的时间[F(3, 270)，P <.05，R² = 0.24]：农村地区（P = 0.04）、全科医生参与情况（P = 0.04）以及是否存在肺癌相关症状（P = 0.02）。
在我们这个人口分布不均且存在地理障碍的地区，居住地对肺癌诊疗路径有影响。农村患者的诊疗路径较短似乎有些矛盾。全科医生更持续的参与可能解释了这一发现，即在无症状或随访时为高危患者建议了更多检查。这并没有改变手术患者的分期，但对于组织有效的肺癌筛查项目可能至关重要。
