Authors: Williams CD, Alpert N, Redding TS, Bullard AJ, Flores RM, Kelley MJ, Taioli E
Title: Racial differences in treatment and survival among veterans and non-veterans with stage I NSCLC: an evaluation of Veterans Affairs (VA) and SEER-Medicare populations.
Journal: Cancer Epidemiol Biomarkers Prev :-
Date: 2019 Oct 17
PubMed ID: 31624076
Abstract: BACKGROUND Surgery is the preferred treatment for Stage I NSCLC with radiation reserved for those not receiving surgery. Previous studies have shown lower rates of surgery among Blacks with Stage I NSCLC than among Whites. METHODS Black and white men aged ≥65 years with stage I NSCLC diagnosed 2001-2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Logistic regression and Cox proportional hazards models were used to examine associations between race, treatment and survival. RESULTS Among the patients in the VA (n=7895) and SEER (n=8744), the proportion of Blacks was 13% and 7%, respectively. Overall, 16.2% of SEER patients (15.4% of Whites, 26.0% of Blacks) and 24.5% of VA patients received no treatment (23.4% of Whites, 31.4% of Blacks). In both cohorts, Blacks were less likely to receive any treatment compared to Whites (ORadj: 0.57, 95% CI: 0.47-0.69 for SM, ORadj: 0.68, 95% CI: 0.58-0.79 for VA). Among treated patients, Blacks were less likely than Whites to receive surgery only (ORadj: 0.57, 95% CI 0.47-0.70 for SM, ORadj: 0.73, 95% CI 0.62-0.86 VA), but more likely to receive chemotherapy only and radiation only. There were no racial differences in survival. CONCLUSION Among VA and SEER-Medicare patients, Blacks were less likely to get surgical treatment. Blacks and Whites had similar survival outcomes when accounting for treatment. IMPACT This supports the hypothesis that equal treatment correlates with equal outcomes and emphasizes the need to understand multi-level predictors of lung cancer treatment disparities.