No matter how successful a surgery is, lung cancer patients have a higher chance of death within 30 days of their operation if they are at a low socioeconomic level. A recent publication from the Journal of the American College of Surgeons, written by principal investigator Felix G. Fernandez, MD, FACS at Emory University School of Medicine in Atlanta, indicated that people who have limited education and low income are less likely to survive following lung cancer surgery than those with higher education and superior financial standing.
“It’s a very powerful study because it has the largest and most complete data on cancer care that we have for our use in the world,” said Dr. Fernandez in a press release from the American College of Surgeons. “Clearly, our results show that patients who come from less educated and less wealthy communities are at risk for mortality with the lung cancer operation,” he said, in reference to the publication, entitled “Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base.”
As indicated, Dr. Fernandez and colleagues analyzed data from over 215,000 lung cancer patients who underwent surgery between 2003 and 2011. Data were a part of the National Cancer Database, which accounts for approximately 70% of the documented, newly diagnosed cancer cases in the United States each year. The large sum of information includes patient demographics, insurance status, diagnosis, treatment, and length of survival beyond treatment.
The goal of the study was to determine clinical and socioeconomic factors that lead to differences in patient outcomes following surgery for lung cancer. “In order to get uniform superior outcomes for our patients, we need to identify the patients who are at risk for worse outcomes,” said Dr. Fernandez. “This is the first step in describing where those disparities exist.”
Old age, male gender, multiple co-morbidities, late-stage cancer, and large tumor size were all associated with a greater risk of mortality 30 days following lung cancer surgery. Independent of these clinical and demographic factors, living in low income households in less educated communities also contributed to a lower chance of survival.
Part of the reason for lower survival was attributed to the type of center patients accessed. Those who underwent surgery at a community hospital were 34% more likely to die following surgery than those who visited an academic medical center, and those who were treated at a comprehensive center were 22% more likely.
“The quality of care needs to be uniform across the country for high risk procedures, so that regardless of the treatment center, whether it is a community hospital or big academic tertiary care center, the results are going to be similar,” said Dr. Fernandez. With poverty levels increasing in the United States, researchers agree that this is a growing concern that needs to be addressed.