The following is a summary of “Association of Neighborhood Socioeconomic Disadvantage with Utilization of Minimally Invasive Resection for Non-Small Cell Lung Cancer,” published in the December 2023 issue of Cardiology by Sakowitz et al.
The aim of this study was to evaluate the factors associated with the utilization of minimally-invasive resection (MIS) procedures for treating surgically resectable Non-Small Cell Lung Cancer (NSCLC), known for reduced postoperative complications. Analyzing data from the National Cancer Database (2010-2020) on adults undergoing lobectomy/sublobar resection for stage I NSCLC, patients were categorized into MIS (thoracoscopic/robotic procedures) or Open groups. Hospitals were stratified based on MIS procedure volumes. Multivariable models assessed patient, disease, and hospital-related factors associated with receiving MIS.
Among 217,762 patients, 112,304 (52%) underwent MIS, a notable increase from 27% in 2010 to 72% in 2020. After adjusting for various factors, lower median neighborhood income quartiles were independently associated with reduced odds of receiving MIS (51st-75th percentile AOR 0.92, 95% CI 0.89-0.94; 26th-50th percentile AOR 0.86, CI 0.83-0.89; 0-25th percentile AOR 0.78, CI 0.75-0.81; Reference: 76th-100th percentile income). Additionally, care at community hospitals was associated with lower odds of undergoing MIS (AOR 0.70, CI 0.68-0.71; Reference: academic centers). Among patients at high MIS volume centers, the lowest income was linked with reduced MIS likelihood from 2010-2015 (AOR 0.85, CI 0.77-0.94) but not in subsequent years (AOR 1.01, CI 0.87-1.16; Ref: highest income).
The study revealed income-based disparities in access to MIS as the primary surgical approach for NSCLC. Community hospital care and lower neighborhood income were associated with decreased odds of undergoing MIS, highlighting the need for interventions to ensure equitable access to minimally invasive surgery and broaden access to high MIS volume centers.
Source: sciencedirect.com/science/article/pii/S0022522323011959
