Assessing Access to And Outcomes of Medical Oncology and Radiation Oncology Consultation in Non-Small Cell Lung Cancer Patients: A Population-Based Study Using Administrative Data
Main Article Content
Abstract
Background: Therapeutic advances in non-small cell lung cancer (NSCLC) have shifted treatment away from chemotherapy towards immunotherapy, monoclonal antibody, and tyrosine kinase inhibitor therapy. Most studies focusing on access to specialist care and lung cancer treatment were conducted before novel therapeutic strategies in NSCLC. This study aimed to better understand and inform referral practices for patients with NSCLC in Ontario.
Methods: A retrospective population-based study using linked administrative healthcare data was conducted between 2010 and 2019. The study cohort was defined as patients, aged 18 years of age or older, with a stage I to IV NSCLC diagnosis in Ontario. Primary outcome: medical oncology or radiation oncology consultation within 120 days of diagnosis. Prognostic factors for consultation and receipt of treatment were identified using logistic regression.
Results: 73,849 patients were diagnosed with NSCLC with 61.3% and 50.9% receiving a medical oncology or radiation oncology consultation respectively. The median time to consultation was 24 days (interquartile range [IQR] 13-49 days). As the stage increased, consultation was more likely (odds ratio [OR] 6.07, 95% CI 5.78-6.38). As the distance to the nearest cancer center increased consultation was less likely (OR 0.72, 95% CI 0.67-0.78). Stage III NSCLC and patients aged 40-44 years were more likely to receive treatment OR 4.09 (95%CI 3.82-4.38) and OR 3.28 (95% CI 2.51-4.28) respectively.
Conclusion: Even in a universal health care system, socioeconomic factors impact a patient’s access to specialist care. Given newer, more effective therapeutic options for NSCLC, access to specialist care must be equitable.
Article Details
How to Cite
FEBBRARO, Michela; JUERGENS, Rosalyn; POND, Gregory R.
Assessing Access to And Outcomes of Medical Oncology and Radiation Oncology Consultation in Non-Small Cell Lung Cancer Patients: A Population-Based Study Using Administrative Data.
Medical Research Archives, [S.l.], v. 11, n. 7.2, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4130>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i7.2.4130.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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37. Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, et al. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Heal. 2023;22(1):20.
38. Hoffman RM, Reuland DS, Volk RJ. The Centers for Medicare & Medicaid Services Requirement for Shared Decision-making for Lung Cancer Screening. Jama. 2021;325(10):933–4.
2. Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res. 2016;5(3):288–300.
3. Jordan EJ, Kim HR, Arcila ME, Barron D, Chakravarty D, Gao J, et al. Prospective Comprehensive Molecular Characterization of Lung Adenocarcinomas for Efficient Patient Matching to Approved and Emerging Therapies. Cancer Discov. 2017;7(6):596–609.
4. Ellison LF. Progress in net cancer survival in Canada over 20 years. Health Rep. 2018;29(9):10–8.
5. Arbour KC, Riely GJ. Systemic Therapy for Locally Advanced and Metastatic Non–Small Cell Lung Cancer. Jama. 2019;322(8):764–74.
6. Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non–Small-Cell Lung Cancer With PD-L1 Tumor Proportion Score ≥ 50%. J Clin Oncol. 2021;39(21):2339–49.
7. Felip E, Altorki N, Zhou C, Csőszi T, Vynnychenko I, Goloborodko O, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB–IIIA non-small-cell lung cancer (IMpower010): a randomized, multicentre, open-label, phase 3 trial. Lancet. 2021;398(10308):1344–57.
8. Spigel DR, Faivre-Finn C, Gray JE, Vicente D, Planchard D, Paz-Ares L, et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer. J Clin Oncol. 2022;JCO2101308.
9. Ahern E, Solomon BJ, Hui R, Pavlakis N, O’Byrne K, Hughes BGM. Neoadjuvant immunotherapy for non-small cell lung cancer: right drugs, right patient, right time? J Immunother Cancer. 2021;9(6):e002248.
10. Lindeman NI, Cagle PT, Aisner DL, Arcila ME, Beasley MB, Bernicker E, et al. Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors: Guideline From the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142(3):321–46.
11. Sharma SV, Bell DW, Settleman J, Haber DA. Epidermal growth factor receptor mutations in lung cancer. Nat Rev Cancer. 2007;7(3):169–81.
12. Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, et al. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. New Engl J Med. 2020;382(1):41–50.
13. Ganti AK, Hirsch FR, Wynes MW, Ravelo A, Ramalingam SS, Ionescu-Ittu R, et al. Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer. Clin Lung Cancer. 2017;18(6):640-650.
14. Jacobsen MM, Silverstein SC, Quinn M, Waterston LB, Thomas CA, Benneyan JC, et al. Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review. Lung Cancer. 2017;112:156–64.
15. Statistics Canada. Population Estimates, Quarterly. Updated June 22, 2023. Accessed June 22, 2023. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901
16. Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer: a systematic review. Thorax. 2009;64(9):749.
17. Nwagbara UI, Ginindza TG, Hlongwana KW. Health systems influence on the pathways of care for lung cancer in low- and middle-income countries: a scoping review. Globalization Health. 2020;16(1):23.
18. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al. Durvalumab after Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer. New Engl J Medicine. 2017;377(20):1919–29.
19. O’Brien M, Paz-Ares L, Marreaud S, Dafni U, Oselin K, Havel L, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stage IB–IIIA non-small-cell lung cancer (PEARLS/KEYNOTE-091): an interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol. 2022;23(10):1274–86.
20. Wakelee HA, Altorki NK, Zhou C, Csőszi T, Vynnychenko IO, Goloborodko O, et al. IMpower010: Primary results of a phase III global study of atezolizumab versus best supportive care after adjuvant chemotherapy in resected stage IB-IIIA non-small cell lung cancer (NSCLC). J Clin Oncol. 2021;39(15_suppl):8500–8500.
21. Wu YL, Tsuboi M, He J, John T, Grohe C, Majem M, et al. Osimertinib in Resected EGFR-Mutated Non–Small-Cell Lung Cancer. New Engl J Med. 2020;383(18):1711–23.
22. Hanna NH, Temin S, Masters G. Therapy for Stage IV Non–Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update Summary. J Clin Oncol. 2020;38(14):1608–32.
23. Hanna NH, Robinson AG, Temin S, Baker S, Brahmer JR, Ellis PM, et al. Therapy for Stage IV Non–Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update. J Clin Oncol. 2021;39(9):1040–91.
24. Takano N, Ariyasu R, Koyama J, Sonoda T, Saiki M, Kawashima Y, et al. Improvement in the survival of patients with stage IV non-small-cell lung cancer: Experience in a single institutional 1995–2017. Lung Cancer. 2019;131:69–77.
25. Lewin G, Morissette K, Dickinson J, Bell N, Bacchus M, Singh H, et al. Recommendations on screening for lung cancer. Can Med Assoc J. 2016;188(6):cmaj.151421.
26. Ho C, Lefresne S, Liberman M, McGuire A, Palma D, Pender A, et al. Lung Cancer in Canada. J Thorac Oncol. 2019;14(7):1128–33.
27. Noonan K, Tong KM, Laskin J, Melosky B, Sun S, Murray N, et al. Referral patterns in advanced non-small cell lung cancer: Impact on delivery of treatment and survival in a contemporary population based cohort. Lung Cancer. 2014;86(3):344–9.
28. Brule SY, Al-Baimani KS, Jonker H, Zhang T, Wheatley-Price P. Palliative chemotherapy (CT) for advanced non-small cell lung cancer (NSCLC): Investigating disparities between patients who are treated versus those who are not. J Clin Oncol. 2015;33(15_suppl):e17681-17681.
29. Goulart BHL, Reyes CM, Fedorenko CR, Mummy DG, Satram-Hoang S, Koepl LM, et al. Referral and Treatment Patterns Among Patients With Stages III and IV Non–Small-Cell Lung Cancer. J Oncol Pract. 2012;9(1):42–50.
30. Gotfrit J, Jonker C, Zhang T, Goss G, Nicholas G, Laurie S, et al. Inpatients versus outpatients with advanced non-small cell lung cancer: Characteristics and outcomes. Cancer Treat Res Commun. 2019;19:100130.
31. Dawe DE, Pond GR, Ellis PM. Assessment of Referral and Chemotherapy Treatment Patterns for Elderly Patients With Non–small-Cell Lung Cancer. Clin Lung Cancer. 2016;17(6):563-572.
32. Canadian Partnership Against Cancer. Lung Cancer and Equity Report Updated 2020. Accessed June 22, 2023. https://www.partnershipagainstcancer.ca/topics/lung-cancer-equity/path-forward/
33. Rivera MP, Katki HA, Tanner NT, Triplette M, Sakoda LC, Wiener RS, et al. Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement. Am J Resp Crit Care. 2020;202(7):e95–112.
34. Slatore CG, Au DH, Gould MK, Group ATSD in H. An Official American Thoracic Society Systematic Review: Insurance Status and Disparities in Lung Cancer Practices and Outcomes. Am J Resp Crit Care. 2010;182(9):1195–205.
35. Sayani A, Vahabi M, O’Brien MA, Liu G, Hwang S, Selby P, et al. Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening. Plos One. 2021;16(5):e0251264.
36. Zarinshenas R, Amini A, Mambetsariev I, Abuali T, Fricke J, Ladbury C, et al. Assessment of Barriers and Challenges to Screening, Diagnosis, and Biomarker Testing in Early-Stage Lung Cancer. Cancers. 2023;15(5):1595.
37. Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, et al. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Heal. 2023;22(1):20.
38. Hoffman RM, Reuland DS, Volk RJ. The Centers for Medicare & Medicaid Services Requirement for Shared Decision-making for Lung Cancer Screening. Jama. 2021;325(10):933–4.