Racial Disparities in Lung Cancer Care

A recent study of disparities in cancer care observed that older, black lung cancer patients may be less likely than other patient groups to receive recommended care.

“While these findings are very concerning, it has always been easier to identify disparities in care than it has been to understand why they persist,” said study author Douglas Arenberg, MD, a pulmonologist, in a statement.

“The level of adherence to lung cancer treatment guidelines in the United States is unclear,” the researchers began. “Also, it is unclear whether previously identified disparities by racial/ethnic group and by age persist across all clinical subgroups.”

The researchers therefore sought to determine what proportion of patients are able to adhere to the National Comprehensive Cancer Network guideline, as well as identify disparities by race/ethnicity and age across clinical subgroups.

Between 2010 and 2014, 441,812 lung cancer cases diagnosed within the National Cancer Database received treatment in line with the aforementioned guidelines. The study team employed multivariable logistic regression models to evaluate potential racial/ethnic and age-related disparities across clinical subgroups and determine if these disparities persist in adjusted analyses taking into account patient, tumor, and health care provider characteristics.

In total, 62.1% of patients received treatment in line with the recommended guidelines; however, this ranged across clinical subgroups from 50.4% to 76.3%. Further, 21.6% (range, 10.3%–31.4%) were not treated, and 16.3% (range, 6.4%–21.6%) received treatment that was less intensive than the guidelines suggest. The most prevalent of the less intensive treatments was conventionally fractionated radiotherapy only (range, 2.5%–16.0%), as well as chemotherapy only for non-metastatic subgroups (range, 1.2%–13.7%) and conventionally fractionated radiotherapy and chemotherapy for localized non-small cell lung cancer (5.9%).

In adjusted analyses, age-related disparities persisted across all clinical subgroups for older patients, who were less likely to receive recommended care (age ≥80 vs. <50: adjusted odds ratio [aOR] 0.12, 95% CI 0.12–0.13). Compared to white patients, black patients were also less likely to receive recommended treatment (aOR 0.78, 95% CI 0.76–0.80). This racial disparity also persisted across clinical subgroups but was less pronounced for extensive disease small cell lung cancer.

The reasons for the disparities were not made clear through the study.

“There may be good reasons why less intensive treatment is in fact medically appropriate,” said Dr. Arenberg. “The National Cancer Database does not include that level of detail.”

The researchers wrote in their conclusion, “Patterns of care among those receiving less intensive treatment than recommended suggest room for improved uptake of treatments such as Stereotactic Body Radiation Therapy among localized non-small cell lung cancer.”