Barriers to surveillance imaging adherence in early-staged lung cancer

Social isolation, coping efficacy, and social well-being over time in patients with lung cancer

BACKGROUND

Little work has examined how coping efficacy and lung cancer-related social isolation relate to social well-being in the context of a patient's computed tomography (CT) scan. Researchers tested the cross-sectional relationship of social isolation and social well-being, and the longitudinal relationship between coping efficacy and social well-being before CT scans.

METHOD

25 patients with lung cancer, within 6 months of their upcoming CT scan, participated. Baseline surveys collected clinical information, demographics, and social isolation; repeated monthly surveys collected coping efficacy and social well-being every 30 days until one's scan.

RESULTS

[Cross-sectional] High levels of social isolation were associated with low levels of social well-being. [Longitudinal] On months patients reported high coping efficacy, they also reported increases in social well-being.

CONCLUSIONS

Social interventions may improve well-being among those with lung cancer as our work shows that getting and receiving support are strongly related to well-being in the time surrounding a scan.

Impact of travel distance on receipt of indicated adjuvant therapy in resected non-small cell lung cancer

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Association between travel distance and overall survival among patients with adrenocortical carcinoma

BACKGROUND AND OBJECTIVES

Regionalization of care is associated with improved perioperative outcomes after adrenalectomy. However, the relationship between travel distance and treatment of adrenocortical carcinoma (ACC) is unknown. We investigated the association between travel distance, treatment, and overall survival (OS) among patients with ACC.

METHODS

Patients diagnosed with ACC between 2004 and 2017 were identified with the National Cancer Database. Long distance was defined as the highest quintile of travel (≥42.2 miles). The likelihood of surgical management and adjuvant chemotherapy (AC) were determined. The association between travel distance, treatment, and OS was evaluated.

RESULTS

Of 3492 patients with ACC included, 2337 (66.9%) received surgery. Rural residents were more likely to travel long distances for surgery than metropolitan residents (65.8% vs. 15.5%, p < 0.001), and surgery was associated with improved OS (HR 0.43, 95% CI 0.34-0.54). Overall, 807 (23.1%) patients received AC with rates decreasing approximately 1% per 4-mile travel distance increase. Also, long distance travel was associated with worse OS among surgically treated patients (HR 1.21, 95% CI 1.05-1.40).

CONCLUSIONS

Surgery was associated with improved overall survival for patients with ACC. However, increased travel distance was associated with lower likelihood to receive adjuvant chemotherapy and decreased overall survival.