Association of Area-level Broadband Access and Non-Small Cell Lung Cancer Diagnosis and Guideline-Concordant Care in the US.
TL;DR
Higher area-level broadband access was associated with better NSCLC outcomes, especially in non-metropolitan areas during the pandemic, and increased broadband access, combined with telehealth waivers during the pandemic may have supported greater access to and continuity of high-quality cancer care.
Abstract
Background
Access to broadband is a social driver of health facilitating healthcare access and reducing travel-related burdens. This study examined associations between area-level broadband access and non-small cell lung cancer (NSCLC) stage at diagnosis, receipt of timely treatment, and guideline-concordant treatment (GCT) before and during the COVID-19 pandemic in the US.
Methods
Patients aged ≥18 years with newly diagnosed NSCLC (2018-2022) were identified from the National Cancer Database. Residential ZIP code-level broadband access, collected from the American Community Survey (2018-2022), was categorized into quartiles. Multivariable logistic regression models examined associations between broadband quartiles and stage at diagnosis, time-to-treatment initiation (TTI), and GCT, stratified by metropolitan status and pandemic period, adjusting for sociodemographic and clinical characteristics.
Results
Among 525,114 patients, compared with those in the lowest broadband quartile, patients in the highest quartile had higher odds of early-stage diagnosis before and during the pandemic (adjusted odds ratio [AOR]=1.18, 95% confidence interval [CI]=1.13-1.22; AOR=1.21, 95%CI=1.17-1.24), timely treatment (AOR=1.13, 95%CI=1.09-1.17; AOR=1.14, 95%CI=1.11-1.18), and GCT (AOR=1.14, 95%CI=1.10-1.19; AOR=1.11, 95%CI=1.07-1.15), with significant positive trends across broadband quartiles. In non-metropolitan areas, significant associations with timely treatment and GCT emerged only during the pandemic.
Conclusion
Higher area-level broadband access was associated with better NSCLC outcomes, especially in non-metropolitan areas during the pandemic. Although broadband access may partly reflect socioeconomic conditions, it may also independently support cancer care access. IMPACT Increased broadband access, combined with telehealth waivers during the pandemic may have supported greater access to and continuity of high-quality cancer care, particularly among patients in non-metropolitan areas.