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Racial disparities in local therapy for early stage non‐small‐cell lung cancer
Author(s) -
Lutfi Waseem,
MartinezMeehan Deirdre,
Sultan Ibrahim,
Evans Nathaniel,
Dhupar Rajeev,
Luketich James D.,
Christie Neil A.,
Okusanya Olugbenga T.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26206
Subject(s) - medicine , hazard ratio , lung cancer , radiation therapy , sabr volatility model , confidence interval , stage (stratigraphy) , proportional hazards model , cancer , surgery , oncology , gastroenterology , paleontology , economics , biology , volatility (finance) , stochastic volatility , financial economics
Objectives This study investigated disparities in the delivery of definitive therapy for early stage non‐small‐cell lung cancer (ESNSCLC) between Caucasian (CS) and African American (AA) populations. Methods The National Cancer Data Base was queried for AA and CS patients, diagnosed with c stage I Non small cell lung cancer between 2004 and 2015. Trends in surgery, stereotactic ablative radiotherapy (SABR), or external beam radiation therapy (EBRT) were compared. Kaplan–Meier and Cox hazards models were used to compare 5‐year overall survival (5YOS). Results A total of 174,338 (90.6%) patients were CS and 18,077 (9.4%) patients were AA. AA patients were less likely to receive surgery (60.3% vs. 66.9%; p < .001) and more likely to receive EBRT (12.4% vs. 10.6%; p < .001); however, there was no significant difference in rates of SABR (8.8% vs. 9.2%; p = .066). From 2004 to 2015, the surgery rates increased for AA patients from 44.4% to 61.8% and for CS patients from 57.6% to 65.6%. AA patients had worse 5YOS on an unadjusted analysis (46.7% vs. 47.9%; p = .009). When adjusted for definitive treatment, AA patients had improved survival (hazard ratio = 0.97, 95% confidence interval = 0.94–0.99). Conclusion Improvements in the delivery of surgery and equal utilization of definitive radiation therapy are at least partially responsible for closing the survival gap between AA and CS patients with ESNSCLC.