Table 1.
Patient Characteristics
| Variable | Evaluation Consistent With Guidelines, NSCLC, Mediastinal Sampling Done First | Evaluation Inconsistent With Guidelines, NSCLC Present, Mediastinal Sampling Performed on the Second or Later Biopsy | Evaluation Not Consistent With Guidelines, NSCLC Present, Mediastinal Sampling Never Done | Small Cell Present, Guideline-Inconsistent, No Mediastinal Sampling on First Test | No Evaluation Recordeda | Total | P Value, χ2 |
|---|---|---|---|---|---|---|---|
| All subjects | 4,044 (100) | 4,254 (100) | 6,194 (100) | 1,422 (100) | 661 (100) | 16,575 (100) | … |
| Age, y | < .0001 | ||||||
| 66-70 | 1,386 (34.3) | 1,390 (32.7) | 1,652 (26.7) | 502 (35.3) | 239 (36.2) | 5,169 (31.2) | |
| 71-75 | 1,225 (30.3) | 1,312 (30.8) | 1,672 (27) | 425 (29.9) | 191 (28.9) | 4,825 (29.1) | |
| 76-80 | 904 (22.4) | 1,009 (23.7) | 1526 (24.6) | 302 (21.2) | 138 (20.9) | 3,879 (23.4) | |
| > 80 | 529 (13.1) | 543 (12.8) | 1,344 (21.7) | 193 (13.6) | 93 (14.1) | 2,702 (16.3) | |
| Sex | < .0001 | ||||||
| Female | 1,999 (49.4) | 2,034 (47.8) | 2,861 (46.2) | 750 (52.7) | 259 (39.2) | 7,903 (47.7) | |
| Male | 2,045 (50.6) | 2,220 (52.2) | 3,333 (53.8) | 672 (47.3) | 402 (60.8) | 8,672 (52.3) | |
| Race | < .0001 | ||||||
| Non-Hispanic white | 3,468 (85.8) | 3,599 (84.6) | 5,051 (81.6) | 1,237 (87) | 537 (81.2) | 13,892 (83.8) | |
| Hispanic | 167 (4.1) | 208 (4.9) | 301 (4.9) | 62 (4.4) | 37 (5.6) | 775 (4.7) | |
| Non-Hispanic black | 290 (7.2) | 261 (6.1) | 590 (9.5) | 80 (5.6) | 56 (8.5) | 1,277 (7.7) | |
| Non-Hispanic other | 119 (2.9) | 186 (4.4) | 252 (4.1) | 43 (3) | 31 (4.7) | 631 (3.8) | |
| Urban/rural | .0009 | ||||||
| Big metro | 2,014 (49.8) | 2,256 (53) | 3,134 (50.6) | 642 (45.2) | 329 (49.8) | 8,375 (50.5) | |
| Metro | 1,257 (31.1) | 1,172 (27.6) | 1,860 (30) | 477 (33.5) | 183 (27.7) | 4,949 (29.9) | |
| Urban | 249 (6.2) | 271 (6.4) | 383 (6.2) | 92 (6.5) | 43 (6.5) | 1,038 (6.3) | |
| Less urban | 426 (10.5) | 451 (10.6) | 679 (11) | 176 (12.4) | 88 (13.3) | 1,820 (11) | |
| Rural | 98 (2.4) | 104 (2.4) | 138 (2.2) | 35 (2.5) | 18 (2.7) | 393 (2.4) | |
| Year of diagnosis | < .0001 | ||||||
| 2004 | 343 (8.5) | 385 (9.1) | 622 (10) | 166 (11.7) | 66 (10) | 1,582 (9.5) | |
| 2005 | 375 (9.3) | 540 (12.7) | 777 (12.5) | 212 (14.9) | 68 (10.3) | 1,972 (11.9) | |
| 2006 | 372 (9.2) | 475 (11.2) | 729 (11.8) | 164 (11.5) | 58 (8.8) | 1,798 (10.9) | |
| 2007 | 396 (9.8) | 452 (10.6) | 715 (11.5) | 153 (10.8) | 71 (10.7) | 1,787 (10.8) | |
| 2008 | 413 (10.2) | 443 (10.4) | 651 (10.5) | 149 (10.5) | 78 (11.8) | 1,734 (10.5) | |
| 2009 | 418 (10.3) | 449 (10.6) | 625 (10.1) | 126 (8.9) | 69 (10.4) | 1,687 (10.2) | |
| 2010 | 374 (9.3) | 396 (9.3) | 534 (8.6) | 136 (9.6) | 54 (8.2) | 1,494 (9) | |
| 2011 | 416 (10.3) | 363 (8.5) | 563 (9.1) | 98 (6.9) | 62 (9.4) | 1,502 (9.1) | |
| 2012 | 472 (11.7) | 395 (9.3) | 512 (8.3) | 120 (8.4) | 69 (10.4) | 1568 (9.5) | |
| 2013 | 465 (11.5) | 356 (8.4) | 466 (7.5) | 98 (6.9) | 66 (10) | 1,451 (8.8) | |
| SEER/TCR region | < .0001 | ||||||
| California | 617 (15.3) | 926 (21.8) | 1,243 (20.1) | 258 (18.1) | 130 (19.7) | 3174 (19.2) | |
| Connecticut | 244 (6) | 226 (5.3) | 268 (4.3) | 58 (4.1) | 43 (6.5) | 839 (5.1) | |
| Detroit | 265 (6.6) | 227 (5.3) | 324 (5.2) | 70 (4.9) | 33 (5) | 919 (5.5) | |
| Georgia | 602 (14.9) | 448 (10.5) | 663 (10.7) | 162 (11.4) | 85 (12.9) | 1,960 (11.8) | |
| Hawaii | 24 (0.6) | 38 (0.9) | 62 (1) | 11 (0.8) | < 11 (1.7) | < 146 (< 0.9) | |
| Iowa | 183 (4.5) | 188 (4.4) | 269 (4.3) | 69 (4.9) | 28 (4.2) | 737 (4.5) | |
| Kentucky | 297 (7.3) | 373 (8.8) | 525 (8.5) | 169 (11.9) | 51 (7.7) | 1,415 (8.5) | |
| Louisiana | 138 (3.4) | 215 (5.1) | 514 (8.3) | 113 (8) | 36 (5.5) | 1,016 (6.1) | |
| New Jersey | 587 (14.5) | 502 (11.8) | 756 (12.2) | 159 (11.2) | 79 (12) | 2,083 (12.6) | |
| New Mexico | 40 (1) | 45 (1.1) | 101 (1.6) | 19 (1.3) | < 11 (< 1.7) | < 216 (< 1.3) | |
| Seattle | 198 (4.9) | 189 (4.4) | 238 (3.8) | 45 (3.2) | 27 (4.1) | 697 (4.2) | |
| Texas | 816 (20.2) | 844 (19.8) | 1,201 (19.4) | 278 (19.6) | 130 (19.7) | 3,269 (19.7) | |
| Utah | 33 (0.8) | 33 (0.8) | 30 (0.5) | 11 (0.8) | < 11 (< 1.7) | < 118 (0.7) | |
| Marital status | < .0001 | ||||||
| Married | 2,233 (55.2) | 2,323 (54.6) | 3,117 (50.3) | 721 (50.7) | 343 (51.9) | 8,737 (52.7) | |
| Not married | 1,525 (37.7) | 1,627 (38.3) | 2,619 (42.3) | 600 (42.2) | 269 (40.7) | 6,640 (40.1) | |
| Unknown | 286 (7.1) | 304 (7.2) | 458 (7.4) | 101 (7.1) | 49 (7.4) | 1,198 (7.2) | |
| Comorbidities | < .0001 | ||||||
| 0 | 1,716 (42.4) | 1,981 (46.6) | 2,480 (40) | 550 (38.7) | 344 (52) | 7,071 (42.7) | |
| 1 | 1,324 (32.7) | 1,302 (30.6) | 1,913 (30.9) | 467 (32.8) | 156 (23.6) | 5,162 (31.1) | |
| ≥ 2 | 1,004 (24.8) | 971 (22.8) | 1,801 (29.1) | 405 (28.5) | 161 (24.4) | 4,342 (26.2) | |
| % Poverty in that patient’s census tractb | < .0001 | ||||||
| ≤ 4.73% | 1,017 (25.2) | 1,084 (25.5) | 1,370 (22.1) | 312 (21.9) | 150 (22.7) | 3,933 (23.7) | |
| 4.74%-9.28% | 932 (23.1) | 1,046 (24.6) | 1,432 (23.1) | 310 (21.8) | 136 (20.6) | 3,856 (23.3) | |
| 9.29%-17.48% | 976 (24.1) | 1,030 (24.2) | 1,507 (24.3) | 401 (28.2) | 166 (25.1) | 4,080 (24.6) | |
| > 17.48% | 1,119 (27.7) | 1,094 (25.7) | 1,885 (30.4) | 399 (28.1) | 209 (31.6) | 4,706 (28.4) | |
| % With < 12 y educationc | < .0001 | ||||||
| ≤ 9.38% | 841 (20.8) | 937 (22) | 1,135 (18.3) | 250 (17.6) | 108 (16.3) | 3,271 (19.7) | |
| 9.39%-17.23% | 979 (24.2) | 1,019 (24) | 1,441 (23.3) | 343 (24.1) | 145 (21.9) | 3,927 (23.7) | |
| 17.24%-28.46% | 978 (24.2) | 1,007 (23.7) | 1,540 (24.9) | 360 (25.3) | 163 (24.7) | 4,048 (24.4) | |
| > 28.46% | 1,246 (30.8) | 1,291 (30.4) | 2,078 (33.6) | 469 (33) | 245 (37.1) | 5,329 (32.2) | |
| Specialty of physician performing first testd | <.0001 | ||||||
| Internal medicine | 320 (7.9) | 1,013 (23.8) | 1,453 (23.5) | 292 (20.5) | 0 | 3,078 (18.6) | |
| Pulmonary | 1,576 (39) | 2,105 (49.5) | 3,154 (50.9) | 811 (57) | 0 | 7,646 (46.1) | |
| General surgery | 299 (7.4) | 137 (3.2) | 222 (3.6) | 53 (3.7) | 0 | 711 (4.3) | |
| Thoracic surgery | 1,560 (38.6) | 254 (6) | 294 (4.8) | 52 (3.7) | 0 | 2,160 (13) | |
| Other | 19 (0.5) | 469 (11) | 708 (11.4) | 135 (9.5) | 0 | 1,331 (8) | |
| Unknown | 270 (6.7) | 276 (6.5) | 363 (5.9) | 79 (5.6) | 661 (100) | 1,649 (10) | |
| Tumor grade | < .0001 | ||||||
| Well differentiated | 92 (2.3) | 165 (3.9) | 186 (3) | < 11 (< 0.8) | 13 (2) | < 467 (< 3) | |
| Moderately differentiated | 722 (17.9) | 1,370 (32.2) | 1,163 (18.8) | < 11 (< 0.8) | 70 (10.6) | <3336 (< 21) | |
| Poorly differentiated | 1,418 (35.1) | 1,869 (43.9) | 2,139 (34.5) | 545 (38.3) | 184 (27.8) | 6,155 (37.1) | |
| Unknown | 1,812 (44.8) | 850 (20) | 2,706 (43.7) | 868 (61) | 394 (59.6) | 6,630 (40) | |
| AJCC stagese | < .0001 | ||||||
| IIA | 392 (9.7) | 496 (11.7) | 251 (4.1) | 78 (5.5) | 24 (3.6) | 1,241 (7.5) | |
| IIB | 560 (13.9) | 1,260 (29.6) | 660 (10.7) | 141 (9.9) | 50 (7.6) | 2,671 (16.1) | |
| IIIA | 2,611 (64.6) | 2,270 (53.4) | 4,300 (69.4) | 1,014 (71.3) | 329 (49.8) | 10,524 (63.5) | |
| IIIB | 481 (11.9) | 228 (5.4) | 983 (15.9) | 189 (13.3) | 258 (39) | 2,139 (12.9) | |
| T stages | < .0001 | ||||||
| T1f | 1,312 (32.4) | 1,120 (26.3) | 1,147 (18.5) | 340 (23.9) | 145 (22.0) | 4,064 (24.5) | |
| T2 | 1,962 (48.5) | 2,614 (61.5) | 3,561 (57.5) | 769 (54.1) | 295 (44.6) | 9,201 (55.5) | |
| T3 | 337 (8.3) | 377 (8.9) | 1,042 (16.8) | 124 (8.7) | 92 (13.9) | 1,972 (11.9) | |
| Unknown | 433 (10.7) | 143 (3.4) | 444 (7.2) | 189 (13.3) | 129 (19.5) | 1,338 (8.1) | |
| N stages | < .0001 | ||||||
| N1 | 1,023 (25.3) | 1,926 (45.3) | 1,132 (18.3) | 234 (16.5) | 93 (14.1) | 4,408 (26.6) | |
| N2 | 2,540 (62.8) | 2,100 (49.4) | 4,079 (65.9) | 999 (70.3) | 310 (46.9) | 10,028 (60.5) | |
| N3 | 481 (11.9) | 228 (5.4) | 983 (15.9) | 189 (13.3) | 258 (39) | 2,139 (12.9) | |
| Cancer type | |||||||
| NSCLC | 3,311 (81.9) | 4,254 (100) | 6,194 (100) | 0 | 527 (79.7) | 14,286 (86.2) | < .0001 |
| Small cell | 733 (18.1) | 0 | 0 | 1,422 (100) | 134 (20.3) | 2,289 (13.8) |
Data are presented as No. (%). AJCC = American Joint Committee on Cancer; NSCLC = non-small cell lung cancer; SEER = Surveillance, Epidemiology, and End Results; TCR = Texas Cancer Registry.
No evaluation recorded means that there are no Medicare payments noted. For example, a patient who had his or her care delivered through the Veteran’s Administration would not show up in the Medicare dataset.
Percentage of the population in the patient’s census tract living below the poverty level. Note that this does not mean the patient’s income is below the poverty line, just that he or she is living in a census tract with that level of poverty.
Percentage of the population in the patient’s census tract that did not graduate 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 scan-guided biopsy, this was the referring physician. Internal medicine includes family practice and all subspecialties of internal medicine other than oncology and pulmonary medicine physicians. Surgery includes all other subspecialties of surgery other than thoracic or cardiothoracic surgery. Thoracic surgery and cardiothoracic surgery are included under thoracic surgery.
Strata with cell counts of ≤ 10 patients and its row margins were suppressed as per National Cancer Institute policy and are reported as “< 11” to ensure confidentiality. A total of 115 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.
Stage from SEER data is based on all TNM data; thus, for patients who had mediastinal sampling, this is based on tissue. For patients who never had sampling, it is clinical-radiographic N stage.