Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer

BACKGROUND National Comprehensive Cancer Network recommends surgical resection for stage I small cell lung cancer (SCLC). Despite these recommendations and the curative potential of such surgery, many continue to underutilize surgery. Our aim is to investigate factors that contribute to underutilization of surgery for Stage I SCLC. METHODS The National Cancer Database was queried to identify patients with SCLC Stage I-IV from 2004-2018. Staging was defined by the American Joint Committee on Cancer guidelines. Cochran-Armitage analysis was performed to analyze trends in surgical treatment for patients diagnosed with Stage I SCLC. Multivariable logistic regression assessed relationships between patient factors and surgical treatment. RESULTS A total of 296,583 patients were diagnosed with SCLC. Of the Stage I patients (n=13,003), only 29.4.% (n=3,823) underwent surgery. Trend analysis demonstrated increased frequency of surgical treatment for Stage I SCLC over years 2004 to 2017, from 14.9% to 39.6% (p<0.0001). Factors that were associated with under-utilization of surgery for Stage I SCLC include African-American race, lower median income, non-private insurance or Medicare, community facility, and geographic regions other than the Northeast. CONCLUSIONS Surgical treatment for Stage I SCLC remains under-utilized and our study identifies significant associated factors. The recognition of these factors may help patients overcome barriers to receiving recommended treatments, improve guideline adherence, and overall quality of care for Stage I SCLC patients.