Background: Centralization has been advocated for both cystectomy and pneumonectomy, since it has been associated with reductions in mortality. Racial disparities exist for both lung and bladder cancer surgical outcomes despite trends in hospital centralization. We hypothesized that disparities exist in the centralization process for both lung and bladder cancer surgery, and that this has differentially affected surgical outcomes in black and white patients.
Methods: The study population was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) database spanning 1997 to 2011, and included 26,750 lung cancer surgeries and 8,168 cystectomies. Hospitals were classified according to procedure volume; patient-hospital distance (PHD) and distance to the nearest high volume / very-high volume (HV/VHV) were calculated. Logistic models were performed to determine factors associated with the utilization of HV/VHV or low volume / very-low volume (LV/VLV) hospitals. Additional models were then performed to assess the association between race and in-hospital mortality, stratified according to whether patients used HV/VHV or LV/VLV hospitals.
For cystectomy, PHD increased over the study period while distance to the nearest HV/VHV decreased; for lung cancer surgery, PHD increased but distance to the nearest HV/VHV hospital was constant. For both surgical procedures, black patients experienced increased odds of LV/VLV utilization over time (for lung cancer surgery, ORadj: 1.20; 95%CI [1.01-1.43]; for cystectomy, ORadj: 1.59; 95%CI [1.26-2.02]). When HV/VHV hospitals were located farther from patients, the odds of HV/VHV utilization decreased while the odds of LV/VLV increased for both lung cancer and bladder cancer patients. Lung cancer and bladder cancer in-hospital mortality was higher in blacks (ORadj: 1.50; 95%CI [1.21-1.86]; ORadj: 1.80; 95%CI [1.12-2.90], respectively) compared to whites.
Racial differences persisted in hospital utilization and in surgical outcome for both lung and bladder cancers. While proximity and insurance are important determinants of quality care, other personal and community variables not captured by SPARCS are influential in lung and bladder surgical treatment and ultimately outcome. Specific interventions are needed to address accessing and utilizing quality care in underserved populations, including black and low SES patients, and patients with large distances from high-volume hospitals.
Citation Format: Wil Lieberman-Cribbin, Martin Casey, Matthew Galsky, Apichat Tantraworasin, Bian Liu, William Oh, Raja Flores, Emanuela Taioli. Effect of centralization on health disparities in lung and bladder cancer surgery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5278. doi:10.1158/1538-7445.AM2017-5278