3805 - Persistent Rural-Urban Disparities in Lung Cancer Survival within an Academic Treatment Setting: Implications for Equitable Radiation Oncology Delivery

Purpose/Objective(s): Kentucky has the highest incidence rate of lung cancer in the nation, with Appalachian and rural communities being most affected. This study compared differences in treatment outcomes for lung cancer patients treated at academic versus non-academic facilities across the state.

Materials/Methods: We utilized the Kentucky Cancer Registry (KCR) to identify a cohort of lung cancer patients treated at a state facility from 2018 to 2022. Each case was stratified by facility type, demographics (age, race, sex, location), insurance type, smoking history, cancer stage, and treatment modality. Continuous variables are reported as means (standard deviations) and medians (interquartile ranges), and categorical variables as counts and proportions. Comparisons were analyzed using chi-squared tests (categorical) and t-tests (continuous).

Results: Of 22,242 patient cases, 3,007 were treated at academic and 19,235 at non-academic facilities. Statistically significant associations (p < 0.05) were observed between facility type and diagnosis year, demographics, insurance type, smoking status, and treatment modality (surgery, radiation, and immunotherapy). A Kaplan-Meier analysis showed that patients treated at academic facilities had higher survival rates than those treated at non-academic centers (p < 0.0001). Survival tables further demonstrated a longer survival period among patients treated at academic facilities, with first-year survival being 60.7% (95% CI [58.9, 62.5]) for academic center patients and 54.2% (95% CI [53.5, 54.9]) for non-academic center patients.

Conclusion: Patients treated at academic centers in Kentucky had improved survival compared to those at non-academic centers. Factors influencing these differences need to be further investigated to enhance outcomes across the state. Understanding the exact etiology of these differences in social and structural determinants will help to pave the way for scalable state-wide and national initiatives to actively close the gap here and across other rural communities across the country.