Dell Medical School Department of Internal Medicine, Austin, TX
Christopher O. Ruud , Henry T Robertson , Christopher J Kim , Paul Zito , Dennis Wylie , Junfeng Jiao
Background: A review of the North American Cancer Registries (NAACCR) found that only 66.4% of Stage I, II NSCLC patients received curative surgery. Mapping treatment would reveal the neighborhoods with undertreated patients. Central Texas is ideal for mapping with no competing causes for clustering of cases, no EPA superfund sites and radon is distributed evenly. Aim: Define the location of NSCLC cases by staging, treatment, and survival in the Austin Metro area to guide targeted interventions. Methods: Cancer Registries at Seton and St David’s Hospitals were queried for NSCLC Diagnosed 2004-2014, Age < 80, Address in 5 county metro, excluding resident of chronic care facility, homeless. A total of 2822 patients were identified (Stage I,II = 759, Stage III = 465, Stage IV = 941, and 99 = 657) . Using the registry records each case was coded for initial treatment. The hierarchy for assigning treatment was Chest Surgery, Radiation, Chemotherapy, Metastasectomy. Combined treatment cases were assigned to the higher modality. Results: There was a minor difference from reported curative surgery rate 67% (n = 511) for Stage I, II patients with 11% (n = 82) radiation. Only 16% (n = 119) Stage I, II subjects had no treatment. Forty six percent of Stage III (n = 465) were treated for cure with combined modality therapy, 25% (105) had no treatment. Registrars code 99-unstageable when there is TX, NX, or MX. This group had 46% (n = 304) no treatment patients compared to 35% (n = 329) in stage IV. Overall 30% (n = 857) patients had no treatment, cancer registry entries indicated 48 refused treatment and 70 were considered too fragile to treat. In the entire population, 2% (n = 63) were referred out for initial treatment. Maps comparing treated and untreated patients by stage and follow up days were produced. Conclusions: It is possible to map treatment, stage, and survival. This information should be useful in implementing targeted reduction of the burden of care, screening, and health literacy interventions.
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