Electronic Theses and Dissertations

Meghan Taylor

Date

2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Public Health

Committee Chair

Matthew Smeltzer

Committee Member

Meredith Ray

Committee Member

James Gurney

Committee Member

Raymond Osarogiagbon

Abstract

Lung cancer is the leading cause of cancer-related death in the US. The majority of early stage lung cancer patients are treated with curative-intent surgical resection; however, patients who undergo resection still exhibit poor outcomes, indicating inequitable cancer care. Across three epidemiologic studies related to the surgical treatment of lung cancer, we examined resections from 2009-2019 in the Mid-South region of the US. First, we identified risk factors known preoperatively for 120-day postoperative mortality and constructed a nomogram to predict the probability of 120-day mortality for individual patients. Preoperative risk factors associated with 120-day mortality included age, tumor size, tumor grade, ASA score, Charlson index, neoadjuvant therapy, and extent of resection. Our nomogram demonstrated modest discrimination (optimism-adjusted area under the curve of 0.706). Decision curve analysis illustrated that the nomogram was clinically useful across a range of risk thresholds.Next, we evaluated overall 5-year survival (OS) after curative-intent surgical resection between black and white lung cancer patients. Unadjusted survival estimates showed no difference in 5-year OS between the races. There was significant effect modification by insurance after adjusting for confounders. Among patients on Medicaid, white patients had a significantly higher hazard of death than black patients (HR 1.41; 95% CI: 1.10, 1.79); however, among patients with commercial insurance, whites had a lower hazard of death than blacks (HR 0.89; 95% CI: 0.73, 1.09). Finally, we assessed the quality of surgery between black and white stage I-IIIA non-small cell lung cancer patients who underwent curative-intent surgical resection using four quality metrics. We found that white patients had a significantly higher odds of receiving anatomic resection (OR 1.40; 95% CI: 1.05, 1.86), having adequate lymph node sampling (OR 1.23; 95% CI: 1.02, 1.48), and meeting the National Comprehensive Cancer Networks quality criteria (OR 1.21; 95% CI: 1.01, 1.46) than black patients; yet they had significantly lower odds of receiving a minimally invasive procedure (OR 0.83; 95% CI: 0.69, 0.99). Future research should focus on proper risk stratification of patients who are indicated for surgery and assess how location influences access to care and contributes towards racial disparities in lung cancer care outcomes.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest

Notes

embargoed

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