Online Program

Proximity to Healthcare Facilities and Racial/Ethnic Disparities in Timeliness of Treatment for Lung Cancer Patients (308062)

Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the U.S. Appropriate treatment can improve lung cancer prognosis, especially if it is detected at an early stage. Distance is a barrier to appropriate cancer treatment. Disparities in who receives appropriate treatment for lung cancer have been observed in underserved rural populations with increased travel requirements. The objective of this study is to investigate the relative contribution of a patients’ proximity to healthcare facilities on racial/ethnic disparities in timely receipt of appropriate treatment in non-Small Cell Lung Cancer (NSCLC) patients in California. We studied 22,971 patients diagnosed with stage I/II NSCLC (2006-2015) in the California Cancer Registry. The outcome of this study is timely receipt (within 45 days) of appropriate treatment (according to guidelines). The exposure is patients’ proximity to healthcare facilities determined using a GIS network analysis to compute distance- and travel time-based measures the nearest healthcare facility, from the centroid of the patient’s residential census blockgroup. Multivariable generalized logistic regression models with a binomial distribution and log link function will be used to estimate the effect of patients’ proximity to healthcare facilities on receipt of timely appropriate treatment, adjusting for cancer stage, year, sex, age, insurance type, marital status, facility type, neighborhood socioeconomic status, urbanicity, and neighborhood transportation affordability and walkability, and stratified by race/ethnicity. Overall, 81.39% of patients received appropriate treatment, 57.63% of them within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We hypothesize that a patient’s proximity to healthcare facilities will partially explain racial/ethnic disparities in receipt of appropriate treatment for NSCLC patients in California. Under-treatment and delayed treatment for early stage NSCLC disproportionately affect underrepresented groups and may be partially explained by a patient’s proximity to healthcare facilities. This research is vital to improving our understanding of cancer-related health disparities in both rural and urban regions.