Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.
J Prim Care Community Health. 2022 Jan-Dec;13:21501319221128701. doi: 10.1177/21501319221128701.
Lung cancer screening (LCS) results in earlier detection of malignancy and decreases mortality but requires access to care to benefit. We assessed factors associated with timing of lung cancer diagnosis in the absence of systematic LCS in an urban safety net hospital.
Retrospective chart review was performed of patients with pathologic diagnosis and/or staging of lung cancer at our institution between 2015 and 2018. Patient socio-demographics, disease characteristics, factors associated with access to medical care, and time point and process by which the patient accessed care were collected and analyzed.
In total, 223 patients were identified with median age of 63 years and 57.8% male predominance. Racial distribution was 22.9%, 20.2%, 17.1%, and 9.4% for Black, White, Asian, and Hispanic, respectively. Stage at diagnosis was 8.1%, 4.5%, 17.0%, and 60.5% for stages I, II, III, and IV, respectively. Medicaid (59.6%) and Medicare/Medicaid (17.1%) were the most common insurance types, while 16.1% had no insurance. A majority (54.3%) had no established primary care provider (PCP), and only 17.9% had an in-network PCP. Patients without PCPs were more likely to have diagnostic evaluation initiated from Emergency Department or Urgent Care settings (95.0% vs 50.1%, < .01) and present with later stage disease (92.7% vs 77.8%, < .01). Of the 83 patients that met age and smoking history LCS criteria, only 33.7% (12.6% of total) also had an in-network PCP.
Absence of established PCPs is associated with later stage presentation of lung cancer and may limit system- level benefits of LCS implementation.
肺癌筛查（LCS）可更早地发现恶性肿瘤并降低死亡率，但需要获得医疗服务才能从中受益。我们评估了在没有系统的 LCS 的情况下，在城市医疗保障医院中与肺癌诊断时间相关的因素。
对 2015 年至 2018 年在我院进行病理诊断和/或肺癌分期的患者进行了回顾性图表审查。收集并分析了患者的社会人口统计学特征、疾病特征、获得医疗服务的相关因素以及患者获得医疗服务的时间点和流程。
共确定了 223 名患者，中位年龄为 63 岁，男性占 57.8%。种族分布分别为黑人 22.9%、白人 20.2%、亚洲人 17.1%和西班牙裔 9.4%。诊断时的分期分别为 I 期 8.1%、II 期 4.5%、III 期 17.0%和 IV 期 60.5%。最常见的保险类型是医疗补助（Medicaid，59.6%）和医疗保险/医疗补助（Medicare/Medicaid，17.1%），而 16.1%的患者没有保险。大多数（54.3%）没有固定的初级保健提供者（PCP），只有 17.9%的患者有联网的 PCP。没有 PCP 的患者更有可能从急诊或紧急护理机构开始进行诊断评估（95.0%比 50.1%，<.01），并且疾病分期更晚（92.7%比 77.8%，<.01）。在符合年龄和吸烟史 LCS 标准的 83 名患者中，只有 33.7%（占总数的 12.6%）也有联网的 PCP。
没有固定的 PCP 与肺癌的晚期表现相关，可能限制了 LCS 实施的系统效益。
