Health care disparity: An analysis of breast, colon, and lung cancer

6579 Background: Lung cancer patients are associated with feeling of guilt about their disease (Schmidt ASCO 2006) and less likely to be referred to specialists (Wassenaar ASCO 2006). They are also commonly affected by smoking related comorbidities. A study was undertaken to evaluate whether treatment differences between lung and other cancers exist. Methods: Public access data for the year 2005 from the National Cancer Data Base (NCDB) was analyzed. Treatment data were categorized by institution (teaching/research [TR] versus community cancer center [CC]) and tumor type (non-small cell lung cancer-NSCLC, breast, colon cancer). Descriptive analysis was performed with student T tests for proportions. Results: The analysis included 18,960 NSCLC patients from a CC and 33,924 from a TR. More patients at TR than CC had surgery: Stage I 65% vs 52% (p < 0.001), Stage II 35% vs 22% (p < 0.001), respectively. The frequency of chemoradiation for stage I and II was higher in CC than TR: stage I 6% vs 3% (p = 0.10), stage II 19% vs 9% (p = 0.004). The frequency of no first course treatment at initial presentation at CC and TR were the following: stage I 15% vs 6%, stage II 18% vs 8%, stage III 21% vs 19%, stage IV 30% vs 24%. For breast and colon cancer, no major differences in no first course treatments were seen between TR and CC in a stage based analysis. More patients with NSCLC (21.2%) did not receive first course treatment in comparison to breast (3.4%, p < 0.001) or colon cancer (7.8%, p < 0.001). These differences were maintained in stage based analysis of the three tumor types. Conclusions: NSCLC patients are at higher risk of not receiving treatment as opposed to those with breast and colon cancer. While medical comorbidities in lung cancer patients may affect these treatment decisions, we noted a higher incidence of no first course treatment in CC than TR centers. For stage I and II, the frequency of no first course treatment in a CC was twice that of a TR. Such institution based differences were not noted in breast and colon cancer. No significant financial relationships to disclose.

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Why are oncologists not testing all NSCLC patients for biomarkers in the U.S. market?

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21003 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21003-e21003

Author(s):

Daniel F. Winkelman ◽

Vaibhav M. Varkhedkar ◽

Holly Stellander-Amato ◽

Lesley Bailey ◽

Anise Kachadourian

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Early Stage ◽

Disease Patient ◽

The United States ◽

Tumor Type ◽

Tumor Sample ◽

Lung Cancer Patients ◽

Biomarker Testing ◽

Nsclc Patients

e21003 Background: NSCLC has the greatest number of biomarkers of any tumor type. If a patient is not biomarker tested, he or she may not receive access to targeted therapies that often offer greater efficacy through personalized therapy. The purpose of this research study is to examine the reasons certain lung cancer patients are not tested in the United States for biomarkers. Methods: This study followed market research best practices. The study was based on a survey of the BrandImpact Oncology panel conducted on patient visits during Q4 2020 at the point-of-prescribing. Results: The baseline measure of NSCLC patients that were being treated but had a biomarker status that was unknown ranges from 9% to 12% of patient visits. The biomarkers examined included ALK, ROS-1, EGFR and PD-L1. The Oncologists who treat NSCLC patients received the following question: When treating patients in your practice with NSCLC cancer what are your top 3 reasons for not conducting biomarker testing? As outlined in the table below which reflects all survey responses, the top four reasons for not conducting biomarker testing are: not enough tumor sample for testing purposes, patient has early stage of disease, patient is not healthy enough and patient cost associated with testing. Conclusions: The overall results indicate the absence of biomarker testing for lung cancer patients is mainly due to two different patient types. The early-stage patient was a key reason for not testing despite advances in early stage indications and diagnostic technology which provide increasing evidence that testing should be done earlier in the treatment journey. The late-stage patient which is seen more often in Academic institutions and who often has more aggressive cancer. The speed of receiving the biomarker test results for these more severe patients likely needs to be addressed. In the Community, setting cost of branded therapies can be an issue and in some cases biomarker testing is not readily available in all practices. It should also be noted that “not enough tumor sample for testing” was the number one reason for not conducting biomarker testing, but this issue can now be addressed through liquid NGS technology.[Table: see text]

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