Abstract 4815: Time to lung cancer treatment in West Virginia and patient survival
Authors: Lumadue Anna R. , Nduaguba Sabina O. 
Published: March 2024

Abstract
Background: Patients from rural areas typically have poor access to healthcare. Studies have shown varying results on the relationship between time to lung cancer treatment and patient survival. We aimed to examine the association of rurality with timely receipt of lung cancer treatment and survival in West Virginia (WV).
Methods: A retrospective study was conducted using WV Cancer Registry data to identify persons diagnosed with NSCLC in WV between 1993 and 2021 who received treatment (surgery, radiation, systemic therapy, other). Participants were classified by rurality (rural vs non-rural), and time to treatment from diagnosis was dichotomized as early treatment (&lt;35 days) or delayed treatment (≥35 days). Descriptive statistics and survival analysis (with univariate and multivariate Cox regression controlling for age, sex, race/ethnicity, marital status, Charlson comorbidity index, cancer stage, and treatment type) were used to address study objectives.
Results: Of 10,463 participants, 678 (6.5%) were rural residents. The majority were male (58.1%), married or partnered (59.9%), and non-Hispanic white (97.5%). 61% received early treatment. 45%, 38%, and 16% received systemic therapy, surgery, and radiation, respectively. There were significantly more non-Hispanic white (99.6% vs 97.3%, p&lt;0.004) patients residing in rural areas compared to non-rural areas, and fewer rural residents were diagnosed at stages 1 (29.4% vs 34.3%) or 2 (10.0% vs 11.6%) (p&lt;0.5). Rurality was not associated with time to treatment but was associated with 9% increase in hazard of death (HR=1.09, 95% CI=1.00-1.18, p&lt;0.05). Significant covariates associated with increasing hazard of treatment included being male (HR=1.08, 95% CI=1.04-1.13, p&lt;0.0001) and cancer stage (HR range=1.19-2.38, while being Black and receiving surgery (0.43, 0.30-0.62, p&lt;.0001), radiation (0.48, 0.33-0.68, p&lt;.0001), or systemic therapy (0.33,0.23-0.47, p&lt;.0001) (compared to other treatment) were each associated with reduced hazard of treatment. Significant covariates associated with hazard of death include increasing age (HR=1.01, 95% CI= 1.01-1.02, p&lt;.0001), increasing CCI (HR=1.07, 95% CI=1.05-1.09, p&lt;.0001), being male (HR=1.21, 95% CI=1.16-1.26, p&lt;.0001), increasing cancer stage (HR range=1.58-4.79) while being married (HR=0.92, 95% CI=0.88-0.96, p&lt;.001), receiving surgery (HR=0.16, 95% CI=1.11-0.22, p&lt;.0001), radiation (HR=0.34, 95% CI=0.24-0.49, p&lt;.0001), or systemic treatment (HR=0.17, 95% CI=0.12-0.24, p&lt;.0001), and delayed treatment (HR=0.82, 95% CI=0.78-0.85, p&lt;.0001) were each associated reduced hazard of death.
Conclusion: Rurality affects lung cancer outcomes in WV increasing risk of death for NSCLC patients by 9%.
Citation Format: Anna R. Lumadue, Sabina O. Nduaguba. Time to lung cancer treatment in West Virginia and patient survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4815.