Geographic Access, Transportation Resources, and Early-Stage Lung Cancer Treatment Among Socioeconomically Disadvantaged Patients
Min Lian, James Struthers, Ying LiuBackground:
A recent study reported that geographic access to cancer care was associated with guideline-recommended treatment for early-stage non–small cell lung cancer (NSCLC), particularly among uninsured and Medicaid patients.
Objective:
To examine whether transportation resources modify the association between geographic access and treatment for early-stage NSCLC.
Methods:
We used Surveillance, Epidemiology, and End Results data linked with Medicaid Analytic eXtracts Personal Summary files to identify patients aged 18 years or above with stage I/II NSCLC diagnosed during 2007–2019 who were uninsured or had Medicaid as primary/secondary payers at diagnosis. Geographic access to thoracic surgeons (TS) and radiation oncologists (RO) was calculated using the 2-step floating catchment area method and categorized into quartiles. Transportation resources were evaluated as county-level vehicle ownership and public transit availability, both dichotomized at the median level. Poisson regression with county-level clustering estimated rate ratios (RRs) for surgery and radiotherapy.
Results:
Geographic access to TS was associated with surgery in both low (RR=0.92, 95% CI: 0.87–0.97 for lowest vs. highest access;
Conclusions:
Local transportation resources modified the association between geographic access and radiotherapy, but not surgery. Improving transportation access may enhance radiotherapy use for NSCLC.