Abstract 4839
Background
Racial and ethnic disparities in cancer care are well described. Lack of access to primary care physicians (PCPs) may be an important contributor to disparities attributed to race and ethnicity. This study examined the effects of primary care access on mortality in lung cancer (LC) patients (pts) in an underserved community.
Methods
Medical records of all pts newly-diagnosed with primary lung cancer between 2012-2016 at a NCI-designated cancer center in the Bronx were reviewed. Demographic data and PCP status were collected. Addresses were correlated with the Health Resources and Services Administration (HRSA) database to identify residences located in primary care shortage areas (PCSAs). Survival data from time of first imaging to death or the end of follow-up on January 1, 2018 were recorded. Data analysis was performed via univariate methods. Survival analysis was performed using Kaplan-Meier and Cox hazards modeling.
Results
Among 1062 pts, 874 (82%) resided in a PCSA, 314 (30%) were Hispanic (H), and 445 (42%) were African-American (AA). Hs and AAs were more likely to reside in PCSAs (p = 0.0002 and p = 0.0008) and in ZIP codes with lower income (both p < 0.0001). Hs and AAs were more likely to depend on public insurance (p = 0.01 and p = 0.02). Pts who live in PCSAs presented at higher stages at the time of diagnosis (p = 0.03) and were diagnosed predominantly in inpatient settings with acute symptoms (p < 0.0001) rather than outpatient clinics (p = 0.0002). In the overall population, PCSA residence (mean: 24 vs. 30 months, p = 0.03, HR = 1.27) and no established PCP (mean: 22 vs. 28 months, p < 0.0001, HR = 1.50) were associated with increased all-cause mortality. In Cox modeling adjusting for stage at diagnosis and PCSA residence, lack of established PCP still predicts increased mortality (p = 0.03, HR = 1.20).
Conclusions
Among new pts with LC, lack of established PCP is associated with increased mortality. Hs and AAs are more likely to reside in PCSAs, suggesting the link between increased mortality and race/ethnicity may be mediated by lack of access to primary care. Our results demonstrate that effective health policy efforts to reduce lung cancer mortality must include approaches to improve access to primary care.
Clinical trial identification
Legal entity responsible for the study
Albert Einstein School of Medicine, Montefiore Medical Center.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
2595 - Real-Life Utilization of Genomic testing for invasive Breast Cancer patients in Italy and France reduces Chemotherapy Recommendations
Presenter: Sandro Barni
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2343 - Benefit of adjuvant chemotherapy in hormone receptor-positive, HER2-negative, invasive lobular carcinoma of the breast
Presenter: Alexandre De Nonneville
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2990 - Baseline lymphocyte counts predict distant recurrence in early breast cancer
Presenter: Gun Min Kim
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4532 - A propensity score analysis exploring the impact of the addition of adjuvant chemotherapy (aCT) to hormone therapy (aHT) in a multi-center series of resected luminal early stage pure Invasive Lobular Breast Carcinoma (ILC).
Presenter: Luisa Carbognin
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2344 - Benefit of Adjuvant Systemic Therapies in HR+ HER2- pT1ab Node-Negative Breast Carcinomas
Presenter: Alexandre De Nonneville
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3525 - Anti-proliferative effect of oral metronomic vinorelbine in PAM50 Luminal/HER2-negative early breast cancer (SOLTI-1501 VENTANA): an open-label, randomized, three-arm, multicenter, window-of-opportunity study
Presenter: Aleix Prat
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3908 - Clinicopathologic significance of androgen receptor expression and discordant receptor status during progression in breast cancer
Presenter: Chan Heun Park
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4075 - The outcomes of early breast cancers utilizing the Oncotype Dx Recurrence score (RS) instead of Clinico-pathological (CP) factors for prognostic risk assessment: A Single Institution Experience
Presenter: Adhar Alsayed
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
738 - Circulating tumor cells as a prognostic marker in non metastatic breast cancer patients.
Presenter: Summar Elmorshidy
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3151 - Molecular subtyping of breast cancer by dedicated breast PET
Presenter: Satoshi Sueoka
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract