Rural‐urban survival disparities for patients with surgically treated lung cancer

BACKGROUND: Nonsmall‐cell lung cancer (NSCLC) is a common diagnosis among patients living in rural areas and small towns who face unique challenges accessing care. We examined differences in survival for surgically treated rural and small‐town patients compared to those from urban and metropolitan areas. METHODS: The National Cancer Database was used to identify surgically treated NSCLC patients from 2004 to 2016. Patients from rural/small‐town counties were compared to urban/metro counties. Differences in patient clinical, sociodemographic, hospital, and travel characteristics were described. Survival differences were examined with Kaplan–Meier curves and Cox proportional hazards models. RESULTS: The study included 366 373 surgically treated NSCLC patients with 12.4% (n = 45 304) categorized as rural/small‐town. Rural/small‐town patients traveled farther for treatment and were from areas characterized by lower income and education(all p < 0.001). Survival probabilities for rural/small‐town patients were worse at 1 year (85% vs. 87%), 5 years (48% vs. 54%), and 10 years (26% vs. 31%) (p < 0.001). Travel distance >100 miles (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.07–1.16, vs. <25 miles) and living in a rural/small‐town county (HR = 1.04, 95% CI: 1.01–1.07) were associated with increased risk for death. CONCLUSIONS: Rural and small‐town patients with surgically treated NSCLC had worse survival outcomes compared to urban and metropolitan patients.