# Socioeconomic Factors Associated with Receipt of Minimally Invasive Surgery for NSCLC: Evidence from the National Cancer Database

## TL;DR

This study finds that patients in lower-income areas are less likely to receive advanced lung cancer surgeries like RATS and VATS compared to those in higher-income areas.

## Contribution

The study reveals socioeconomic disparities in access to minimally invasive lung cancer surgeries using nationwide data.

## Key findings

- Patients in low-income neighborhoods were less likely to receive RATS or VATS compared to those in high-income areas.
- Community hospitals were significantly less likely to offer RATS or VATS compared to academic centers.

## Abstract

It is not well understood how the neighborhood-level socioeconomic context shapes the likelihood of receiving minimally invasive surgical approaches, including RATS and VATS, for lung cancer. Using the National Cancer Database from 2015 to 2022, we analyzed 84,931 patients with non-small lung cancer (NSCLC) who underwent surgery. We compared three types of surgery: open thoracotomy, VATS, and RATS. Patients from the lowest-income neighborhoods were less likely to receive RATS or VATS compared to those from the highest-income areas, after adjusting for patient, clinical, and hospital factors. We also found that community hospitals were far less likely than academic centers to offer these advanced surgical techniques. Overall, the results show apparent socioeconomic differences in receipt of minimally invasive lung cancer surgery. Access to modern surgical care for patients in disadvantaged communities needs to be improved to reduce these treatment gaps and improve outcomes.

Background: Lung cancer remains the leading cause of cancer-related morbidity and mortality. Despite advances in surgical management, economically disadvantaged patients experience inequalities in the receipt of treatments. We evaluated the association between socioeconomic status (SES) and type of surgery: robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and open thoracotomy. Methods: Data came from the National Cancer Database (2015–2022) and included Stage 0–IIIa NSCLC patients. SES was measured by quartiles of median household income in the patient’s zip code. Adjusted multinomial logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Among 84,931 patients with a mean age of 67.8 years, 38.4% underwent open thoracotomy, 33.3% underwent VATS, and 28.2% underwent RATS. Patients residing in the low-income areas (<$46,277) were significantly less likely to undergo RATS (aOR: 0.79, 95% CI: 0.77–0.86) or VATS (aOR: 0.62, 95% CI: 0.59–0.66) compared to patients living in high-income areas (≥$74,063). Community hospitals were less likely to provide RATS (aOR: 0.32, 95% CI: 0.29–0.35) or VATS (aOR: 0.58, 95% CI: 0.54–0.63) than academic centers. Conclusion: Socioeconomic disadvantage is associated with lower use of minimally invasive surgical approaches for NSCLC. Efforts to expand access to advanced surgical care may be necessary to reduce treatment disparities and improve outcomes.