Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, Houston, Tex.
J Thorac Cardiovasc Surg. 2024 May;167(5):1617-1627. doi: 10.1016/j.jtcvs.2023.08.049. Epub 2023 Sep 9.
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.
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.
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).
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.
我们之前已经证明了旅行距离对接受切除非小细胞肺癌（NSCLC）监测成像指南的负面影响。患者居住地对接受推荐的术后治疗方案的依从性的影响尚不清楚。我们旨在描述旅行距离对接受指示性辅助治疗的影响。
我们对 2012 年至 2016 年间接受初次肺切除术的 II-III 期 NSCLC 患者进行了单机构回顾性研究。收集了临床病理和手术/围手术期治疗的详细信息。从患者家到手术医院测量了旅行距离。我们的主要结果是接受辅助全身或放疗。旅行距离分为<100 英里和>100 英里。进行了多变量逻辑回归分析。
总共有 391 名患者符合纳入标准，平均年龄为 65.9 岁，性别分布相当均衡（女性 182 例，49.2%）。大多数患者是非西班牙裔白人（n=309，83.5%），最常见的临床分期为 II 期（n=254，64.9%）。266 名（71.9%）患者接受了指示性辅助治疗，中位旅行距离为 209 英里（四分位距，50.7-617）。多变量分析显示，旅行距离较长与接受指示性辅助治疗呈负相关（比值比，0.13；95%置信区间，0.06-0.26；P<0.001）。此外，黑人患者接受适当治疗的可能性较低（比值比，0.05；95%置信区间，0.02-0.15；P<0.001）。
旅行距离>100 英里会降低 NSCLC 患者接受指示性辅助治疗的可能性。早期疾病系统治疗的适应证正在迅速扩大，鉴于我们旨在为所有患者提供公平的治疗机会，这些发现具有更高的相关性。
