Limited Access to Cancer Specialists Linked to Lower Treatment Rates and Higher Mortality in Early-Stage Lung Cancer

Patients with early-stage non–small cell lung cancer (NSCLC) living in areas with limited access to thoracic surgeons and radiation oncologists face lower treatment rates and higher cancer-related mortality, according to a population-based study published in JAMA Network Open.

Geographic access to cancer care, including proximity to specialists and treatment facilities, plays a critical role in timely and effective cancer treatment, but evidence on its impact in lung cancer is mixed and limited by methodological differences and narrow study populations. Some studies link long travel distances to worse outcomes in early-stage NSCLC, while others suggest the opposite, highlighting the need for broader, more comprehensive analyses.

“To overcome these limitations, we quantified geographic access to cancer care using a robust geospatial measure integrating travel burden to and availability of nearby thoracic surgeons and radiation oncologists and examined its association with early-stage NSCLC treatment and outcomes,” explained Pratibha Shrestha, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri, and coauthors. “We also assessed this association in patients who generally experience lung cancer treatment and outcome disparities, as geographic accessibility and availability of health care are potential drivers of cancer health disparities,” they continued.

The researchers analyzed data from the SEER registry between 2007 and 2015, integrating advanced geospatial modeling to estimate access to thoracic surgeons and radiation oncologists for each patient’s county of residence.

Among 65 259 patients (mean age, 69.4 years; 51% female), those in counties with the least access to thoracic surgeons were significantly less likely to undergo surgical resection compared with those in counties with the most access (OR, 0.80; 95% CI, 0.69–0.93; P < .001 for trend). The disparity was more pronounced in Asian patients (OR, 0.59) and those on Medicaid (OR, 0.76). In contrast, access to radiation oncologists did not significantly affect radiotherapy use overall (OR, 0.89; 95% CI, 0.77–1.03), though access was significant for specific subgroups such as Hispanic (OR, 0.65), uninsured (OR, 0.63), and older patients (OR, 0.85).

Over a median follow-up of 32 months, lung cancer–specific mortality was significantly higher in counties with the least access to thoracic surgeons (HR, 1.10; 95% CI, 1.03–1.18) and radiation oncologists (HR, 1.11; 95% CI, 1.04–1.18), even after adjusting for sociodemographic factors and cancer stage. These associations weakened slightly after accounting for treatment received, but the link between limited access and poorer outcomes persisted, particularly in younger patients and those in less deprived counties.

“In this cohort study, less geographic access to thoracic surgeons and radiation oncologists was associated with worse survival of patients with early-stage NSCLC,” concluded the study authors.

Reference

Shrestha P, Liu Y, Struthers J, Kozower B, Lian M. Geographic access to cancer care and treatment and outcomes of early-stage non-small cell lung cancer. JAMA Netw Open. 2025;8(3):e251061. doi:10.1001/jamanetworkopen.2025.1061