Diffusion of treatment advances can be “very inefficient,” Dr Unger explained.

“Sometimes, treatments with proven benefit permeate slowly through the treatment community, especially for disadvantaged populations, including those from lower income areas and those in poverty. The appropriate and rapid adoption of new cancer treatments could improve survival for patients with cancer.”

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Patients treated in community-based settings tended to be older and more comorbid, more often white than black, and more frequently covered under Medicare, the Duke team found.1 But survival remained associated with facility type in a multivariate analysis, even after controlling for age, gender, year of diagnosis, insurance type, and tumor histology.1

“We were not able to include comorbidity because it was not part of the dataset until well into our study period,” commented Dr Sendhilnathan Ramalingam.

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The Duke study team also found that in 1998, there was a small,  histology-dependent, 2-year survival disparity  between patients with adenocarcinoma compared with those with squamous cell carcinoma — but this gap in survival between subtypes had grown to a 7.2% difference by 2010 (17.3% vs 10.1%, respectively).1 That finding bolstered earlier work in the early 2000s that suggested an overall survival advantage for patients with adenocarcinoma. And, the arrival of novel targeted therapies is thought to have improved survival times among patients with adenocarcinoma.1,2

However, the NCDB data lacked details on systemic treatment agents, molecular testing, mutational status, or the extent or location of metastatic tumors, complicating efforts to retrospectively assess that hypothesis.1

It is too soon to yet say whether or not survival disparities between community and academic settings have begun to diminish in more recent years across the NCDB data, Dr Sendhilnathan Ramalingam said.