Shortage of Thoracic Surgeons in the United States: Implications for Treatment and Survival for Stage I Lung Cancer Patients

To evaluate if there is a shortage of thoracic surgeons in the U.S. and whether any potential shortage is impacting lung cancer treatment and outcomes.Using the U.S. Area Health Resources File and Surveillance Epidemiology End Results database, we assessed the number of cardiothoracic surgeons per 100,000 people and the number of stage I NSCLC diagnoses in the U.S. in 2010 versus 2018. Changes in the percentage of patients diagnosed with stage I NSCLC who underwent surgery and stereotactic body radiotherapy (SBRT) and changes in overall survival of patients with stage I NSCLC from 2010-2018 in the National Cancer Database were evaluated using multivariable logistic regression and Cox proportional hazards modeling.; From 2010-2018, the number of cardiothoracic surgeons per 100,000 people in the U.S. decreased by 12% (p<0.001), while the number of patients diagnosed with stage I NSCLC increased by 4 0% (p<0.001). Over the same period, the percentage of patients who underwent surgery for stage I NSCLC decreased from 81.0% to 72.3% (adjusted odds ratio [aOR]: 0.59; 95% CI: 0.55 to 0.63); this finding was consistent among a subgroup of young and otherwise healthy patients. Greater decreases in the percentage of patients who underwent surgery in non-metropolitan and underserved regions corresponded with worse improvements in survival among patients in these regions from 2010-2018.Recent declines in the U.S. cardiothoracic surgery workforce may have led to significantly fewer patients undergoing surgery for stage I NSCLC and worsening disparities in survival between different patient populations.