Table 1.
—Patient Characteristics
| Evaluation Inconsistent With Guidelines | ||||||
| Variable | Evaluation Consistent With Guidelines, Mediastinal Sampling Done First | NSCLC Present, Mediastinal Sampling Second or Later | NSCLC Present, Mediastinal Sampling Never Done | Small Cell Lung Cancer Present | No Evaluation Recordeda | Total |
| All patients | 3,155 (100) | 4,659 (100) | 5,881 (100) | 1,621 (100) | 615 (100) | 15,931 (100) |
| Age, y | ||||||
| 66-70 | 1,074 (34.04) | 1,527 (32.78) | 1,549 (26.34) | 571 (35.23) | 196 (31.87) | 4,917 (30.86) |
| 71-75 | 995 (31.54) | 1,566 (33.61) | 1,697 (28.86) | 486 (29.98) | 169 (27.48) | 4,913 (30.84) |
| 76-80 | 761 (24.12) | 1,046 (22.45) | 1,521 (25.86) | 360 (22.21) | 143 (23.25) | 3,831 (24.05) |
| > 80 | 325 (10.3) | 520 (11.16) | 1,114 (18.94) | 204 (12.59) | 107 (17.4) | 2,270 (14.25) |
| Sex | ||||||
| Female | 1,530 (48.49) | 2,146 (46.06) | 2,637 (44.84) | 854 (52.68) | 254 (41.3) | 7,421 (46.58) |
| Male | 1,625 (51.51) | 2,513 (53.94) | 3,244 (55.16) | 767 (47.32) | 361 (58.7) | 8,510 (53.42) |
| Race | ||||||
| Non-Hispanic white | 2,745 (87.01) | 3,989 (85.62) | 4,826 (82.06) | 1,409 (86.92) | 490 (79.68) | 13,459 (84.48) |
| Hispanic | 129 (4.09) | 223 (4.79) | 289 (4.91) | 70 (4.32) | 34 (5.53) | 745 (4.68) |
| Non-Hispanic black | 199 (6.31) | 247 (5.3) | 548 (9.32) | 99 (6.11) | 66 (10.73) | 1,159 (7.28) |
| Non-Hispanic other | 82 (2.6) | 200 (4.29) | 218 (3.71) | 43 (2.65) | 25 (4.07) | 568 (3.57) |
| Urban/rural | ||||||
| Big metropolitan | 1,763 (55.88) | 2,557 (54.88) | 3,092 (52.58) | 799 (49.29) | 320 (52.03) | 8,531 (53.55) |
| Metropolitan | 861 (27.29) | 1,266 (27.17) | 1,625 (27.63) | 481 (29.67) | 181 (29.43) | 4,414 (27.71) |
| Urban | 196 (6.21) | 306 (6.57) | 431 (7.33) | 132 (8.14) | 39 (6.34) | 1,104 (6.93) |
| Less urban | 279 (8.84) | 433 (9.29) | 611 (10.39) | 171 (10.55) | 64 (10.41) | 1,558 (9.78) |
| Rural | 56 (1.78) | 97 (2.08) | 122 (2.07) | 38 (2.34) | 11 (1.79) | 324 (2.03) |
| Year of diagnosis | ||||||
| 1995 | 105 (3.33) | 181 (3.89) | 135 (2.3) | 45 (2.78) | 21 (3.42) | 487 (3.06) |
| 1996 | 88 (2.79) | 183 (3.93) | 150 (2.55) | 58 (3.58) | 21 (3.42) | 500 (3.14) |
| 1997 | 92 (2.92) | 178 (3.82) | 131 (2.23) | 51 (3.15) | 18 (2.93) | 470 (2.95) |
| 1998 | 89 (2.82) | 165 (3.54) | 152 (2.59) | 38 (2.34) | 15 (2.44) | 459 (2.88) |
| 1999 | 86 (2.73) | 131 (2.81) | 107 (1.82) | 48 (2.96) | 24 (3.9) | 396 (2.49) |
| 2000 | 207 (6.56) | 349 (7.49) | 338 (5.75) | 107 (6.6) | 40 (6.5) | 1,041 (6.53) |
| 2001 | 335 (10.62) | 483 (10.37) | 636 (10.81) | 184 (11.35) | 63 (10.24) | 1,701 (10.68) |
| 2002 | 302 (9.57) | 516 (11.08) | 614 (10.44) | 191 (11.78) | 57 (9.27) | 1,680 (10.55) |
| 2003 | 377 (11.95) | 501 (10.75) | 716 (12.18) | 189 (11.66) | 69 (11.22) | 1,852 (11.63) |
| 2004 | 401 (12.71) | 497 (10.67) | 746 (12.69) | 197 (12.15) | 82 (13.33) | 1,923 (12.07) |
| 2005 | 344 (10.9) | 540 (11.59) | 742 (12.62) | 201 (12.4) | 65 (10.57) | 1,892 (11.88) |
| 2006 | 357 (11.32) | 484 (10.39) | 712 (12.11) | 155 (9.56) | 65 (10.57) | 1,773 (11.13) |
| 2007 | 372 (11.79) | 451 (9.68) | 702 (11.94) | 157 (9.69) | 75 (12.2) | 1,757 (11.03) |
| SEER/TCR region | ||||||
| Atlanta and rural Georgia | 68 (2.16) | 164 (3.52) | 218 (3.71) | 44 (2.71) | 14 (2.28) | 508 (3.19) |
| California | 640 (20.29) | 1,011 (21.7) | 1,122 (19.08) | 309 (19.06) | 134 (21.79) | 3,216 (20.19) |
| Connecticut | 239 (7.58) | 392 (8.41) | 327 (5.56) | 108 (6.66) | 53 (8.62) | 1,119 (7.02) |
| Detroit | 353 (11.19) | 387 (8.31) | 477 (8.11) | 115 (7.09) | 42 (6.83) | 1,374 (8.63) |
| Hawaii | 24 (0.76) | 68 (1.46) | 89 (1.51) | 13 (0.8) | 15 (2.44) | 209 (1.31) |
| Iowa | 175 (5.55) | 337 (7.23) | 408 (6.94) | 146 (9.01) | 33 (5.37) | 1,099 (6.9) |
| Kentucky | 209 (6.62) | 353 (7.58) | 475 (8.08) | 171 (10.55) | 37 (6.02) | 1,245 (7.82) |
| Louisiana | 98 (3.11) | 215 (4.62) | 454 (7.72) | 106 (6.54) | 36 (5.85) | 909 (5.71) |
| New Jersey | 395 (12.52) | 462 (9.92) | 576 (9.79) | 144 (8.88) | 64 (10.41) | 1,641 (10.3) |
| New Mexico | 49 (1.55) | 82 (1.76) | 80 (1.36) | 28 (1.73) | < 11 (< 2)b | < 250 (< 1.56) |
| Seattle | 146 (4.63) | 198 (4.25) | 217 (3.69) | 45 (2.78) | 38 (6.18) | 644 (4.04) |
| Texas | 720 (22.82) | 946 (20.31) | 1,393 (23.69) | 374 (23.07) | 135 (21.95) | 3,568 (22.4) |
| Utah | 39 (1.24) | 44 (0.94) | 45 (0.77) | 18 (1.11) | < 11 (< 1)b | < 157 (< 0.99) |
| Charlson comorbidity index | ||||||
| 0 | 1,620 (51.35) | 2,563 (55.01) | 2,740 (46.59) | 784 (48.37) | 332 (53.98) | 8,039 (50.46) |
| 1 | 959 (30.4) | 1,340 (28.76) | 1,800 (30.61) | 498 (30.72) | 148 (24.07) | 4,745 (29.79) |
| 2+ | 576 (18.26) | 756 (16.23) | 1,341 (22.8) | 339 (20.91) | 135 (21.95) | 3,147 (19.75) |
| Poverty in patient’s census tractc | ||||||
| ≤ 4.76% | 886 (28.08) | 1,183 (25.39) | 1,316 (22.38) | 369 (22.76) | 145 (23.58) | 3,899 (24.47) |
| 4.77%-9.07% | 742 (23.52) | 1,194 (25.63) | 1,401 (23.82) | 390 (24.06) | 136 (22.11) | 3,863 (24.25) |
| 9.08%-16.53% | 779 (24.69) | 1,071 (22.99) | 1,461 (24.84) | 417 (25.73) | 155 (25.2) | 3,883 (24.37) |
| > 16.53% | 619 (19.62) | 997 (21.4) | 1,544 (26.25) | 391 (24.12) | 153 (24.88) | 3,704 (23.25) |
| Unknown | 129 (4.09) | 214 (4.59) | 159 (2.7) | 54 (3.33) | 26 (4.23) | 582 (3.65) |
| < 12 y educationd | ||||||
| ≤ 10.09% | 864 (27.39) | 1,239 (26.59) | 1,330 (22.62) | 336 (20.73) | 140 (22.76) | 3,909 (24.54) |
| 10.1%-17.18% | 767 (24.31) | 1,157 (24.83) | 1,392 (23.67) | 413 (25.48) | 145 (23.58) | 3,874 (24.32) |
| 17.19%-27.8% | 765 (24.25) | 1,040 (22.32) | 1,471 (25.01) | 417 (25.73) | 162 (26.34) | 3,855 (24.2) |
| > 27.85% | 630 (19.97) | 1,009 (21.66) | 1,529 (26) | 401 (24.74) | 142 (23.09) | 3,711 (23.29) |
| Unknown | 129 (4.09) | 214 (4.59) | 159 (2.7) | 54 (3.33) | 26 (4.23) | 582 (3.65) |
| Specialty of physician doing first teste | ||||||
| Internal medicine | 368 (11.66) | 1,040 (22.32) | 1,381 (23.48) | 375 (23.13) | 0 (0) | 3,164 (19.86) |
| Pulmonary | 945 (29.95) | 2,300 (49.37) | 2,998 (50.98) | 878 (54.16) | 0 (0) | 7,121 (44.70) |
| General surgery | 298 (9.45) | 196 (4.21) | 244 (4.15) | 74 (4.57) | 0 (0) | 812 (5.10) |
| Thoracic surgery | 1,431 (45.36) | 304 (6.53) | 292 (4.97) | 80 (4.94) | 0 (0) | 2,107 (13.23) |
| Other | 19 (0.6) | 141 (3.03) | 236 (4.01) | 46 (2.84) | 0 (0) | 442 (2.77) |
| Unknown | 94 (2.98) | 678 (14.55) | 730 (12.41) | 168 (10.36) | 615 (100) | 2,285 (14.34) |
| T stage | ||||||
| T1b | 908 (28.78) | 1,105 (23.72) | 869 (14.77) | 322 (19.87) | 133 (21.63) | 3,337 (20.94) |
| T2 | 1,342 (42.54) | 2,633 (56.51) | 2,993 (50.89) | 728 (44.91) | 243 (39.51) | 7,939 (49.83) |
| T3 | 176 (5.58) | 279 (5.99) | 762 (12.96) | 117 (7.22) | 74 (12.03) | 1,408 (8.84) |
| Unknown | 729 (23.11) | 642 (13.78) | 1,257 (21.37) | 454 (28.01) | 165 (26.83) | 3,247 (20.38) |
| Cancer type | ||||||
| NSCLC | 2,680 (84.95) | 4,659 (100) | 5,881 (100) | 0 (0) | 500 (81.3) | 13,720 (86.12) |
| Small cell lung cancer | 475 (15.06) | 0 (0) | 0 (0) | 1,621 (100) | 115 (18.7) | 2,211 (13.88) |
Data are presented as No. (%). NSCLC = non-small cell lung cancer; SEER = Surveillance, Epidemiology, and End Results; TCR = Texas Cancer Registry.
No evaluation recorded means that no Medicare payments were noted. For example, a patient who had their care delivered through the Veteran’s Administration would not show up in the Medicare dataset.
Strata with ≤ 10 patients were suppressed per National Cancer Institute policy and are reported as < 11 to ensure confidentiality. A total of 50 patients with T0 disease have been included in the T1 category to maintain confidentiality because there were too few patients with T0 disease to report them separately while maintaining confidentiality.
Poverty is the percentage of the population in the patient’s census tract living below the poverty level. Note that this does not mean that the patient’s income is below the poverty line, just that the patient is living in a census tract with that level of poverty.
Percentage of patients with < 12 y education is the percentage of the population in their census tract who did not graduate from high school.
Refers to the physician who ordered or performed the first invasive diagnostic test. For bronchoscopy and surgical procedures, this was the physician performing the procedure. For CT image-guided biopsy, this was the referring physician. Internal medicine includes family practice and all subspecialties of internal medicine other than oncology and pulmonary medicine. Surgery includes all other subspecialties of surgery other than thoracic and cardiothoracic. Thoracic surgery and cardiothoracic surgery are included under thoracic surgery.