109. Shortage of Thoracic Surgeons in the United States: Implications for Treatment and Survival for Stage I Lung Cancer Patients

OBJECTIVES:
The objective of this study is to evaluate whether there is a shortage of thoracic surgeons in the U.S. and whether this shortage is impacting lung cancer treatment and outcomes.

METHODS:
Using the United States Area Health Resources File, we assessed changes in the number of thoracic surgeons per 100,000 people in the U.S. in 2010 vs. 2018. Changes in the percentage of patients diagnosed with stage I non-small-cell lung cancer (NSCLC), the percentage of these patients who underwent surgery, and overall survival of patients with stage I NSCLC from 2010-2018 in the National Cancer Database were evaluated using multivariable logistic regression and Cox proportional hazards modeling. A subgroup analysis was conducted of rural and metropolitan areas.

RESULTS:
From 2010-2018, the number of thoracic surgeons per 100,000 people in the U.S. decreased by 12% (p<0.001). Over the same time period, the percentage of patients diagnosed with stage I NSCLC increased by 28% (p<0.001). However, the percentage of these patients who underwent surgery decreased by 7.5% (p<0.001). In a subgroup analysis of rural and metropolitan regions, the number of thoracic surgeons per 100,000 people decreased by 36% in rural regions compared to 4% in metropolitan regions. From 2010-2018, survival of stage I NSCLC patients increased in metropolitan areas but did not increase in rural regions (Figure). When evaluating the trends in the age of thoracic surgeons, from 2010 to 2018, the proportion of older thoracic surgeons (> 65 years) was found to increase by 18% (p=0.02). By 2018, 50% of all thoracic surgeons in rural regions were > 65 years old whereas in metropolitan regions, 22% of thoracic surgeons were > 65 years old.

CONCLUSIONS:
A decline in the number of thoracic surgeons per 100,000 people in the United States, coupled with an increase in the percentage of patients diagnosed with stage I NSCLC, may have led to significantly fewer patients undergoing surgery for stage I NSCLC with resultant worsening disparities in survival between metropolitan and rural areas. Given the significantly fewer surgeons that are now available and an increased number nearing retirement, particularly in rural areas, this health care crisis may negate the efforts by our field to improve outcomes through lung cancer screening initiatives in the near future.

Alexandra Potter (1), Allison Rosenstein (1), Matthew Kiang (2), Olugbenga Okusanya (3), Yolonda Colson (1), Hugh G. Auchincloss (1), Chi-Fu Yang (1), (1) Massachusetts General Hospital, Boston, MA, (2) Stanford University, Stanford, CA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA

Virginia Litle

Invited Discussant

Virginia R. Litle, MD is a graduate of the University of Vermont and received her medical degree from the Brown-Dartmouth Program in Medicine.  Dr. Litle completed her residency in General Surgery at the University of California in San Francisco, CA, and completed fellowships in both Surgical Oncology and Cardiothoracic Surgery at the University of Pittsburgh Medical Center. At St. Elizabeth's Medical Center in Brighton, MA, Dr. Litle is the Chief of Thoracic Surgery and Regional System Medical Director, Thoracic Surgery. Dr. Litle’s provides minimally invasive approaches to benign and malignant esophageal diseases including but not limited to GERD, paraesophageal hernias, achalasia, and esophageal cancer. In addition she treats lung cancer, mediastinal disease including thymomas, and nonthymomatous myasthenia gravis with robotic approaches as clinically appropriate. Dr. Litle’s palliative thoracic interventions include endoscopic ablative therapies of esophageal and airway pathology.  Her particular research interests include risk-stratification for prevention of venothromboembolic (VTE) events following thoracic surgery, disparities in management of thoracic malignancies and esophageal cancer screening with a sponge technique. Dr. Litle is a past president of Women in Thoracic Surgery and a member of the AATS, STS, ESTS, STSA, American Foregut Society, and ISMICS. She serves as Consulting Editor, Thoracic Surgery Clinics, an Associate Editor of The Annals of Thoracic Surgery, Senior Associate Editor of Foregut, Associate Editor for Pearson’s ebook, Treasurer of The Thoracic Surgery Foundation and is a co-chair of the ESTS/AATS VTE Committee. Dr. Litle is married to Tony Godfrey, PhD, and they have three children: Jack, age 24, George, age 22, and Caroline, age 18. Her additional interests include mentorship, global surgery, tennis, skiing, hiking, camping, and all activities outdoors.

Alexandra Potter

Abstract Presenter

Alexandra Potter is a research assistant at Massachusetts General Hospital. Her research focus is in the field of thoracic oncology.

Specialties: Thoracic, Anatomy and Conditions, Lung--Cancer, Treatment/Procedure/Operation/Surgery, Lung--Cancer