This article is more than 5 years old. Information may no longer be current.
Comorbidities do not explain lower surgery rates among blacks with NSCLC
Click Here to Manage Email Alerts
Racial differences in comorbidity do not fully explain why black patients with early-stage non–small cell lung cancer undergo surgery less frequently than white patients, according to study results.
Surgical resection is the recommended therapy for early-stage NSCLC. Prior studies consistently demonstrated white patients are more likely than black patients to undergo surgery for NSCLC, even though historical outcomes are similar between the two groups.
However, the severity of co-morbid conditions can alter treatment course due to the potential for complications during or after surgery.
To determine whether potential racial differences in comorbidities contributed to the racial disparities in rates of surgical resection, Christina D. Williams, PhD, of the Durham VA Medical Center in Durham, N.C., and colleagues analyzed data on 1,314 patients (mean age, 68 years) in the Veterans Health Administration who were diagnosed with early-stage NSCLC in 2007.
The analysis included 1,135 white patients and 179 black patients.
Williams and colleagues used generalized linear models with a logit link accounting for patient clustering within VA medical centers to determine the effect of comorbidities on surgery rates.
The analysis showed black patients had higher rates of hypertension (73.2% vs. 63.6%; P=.002), liver disease (11.2% vs. 4%; P<.001), end-stage renal disease (12.3% vs. 4.9%; P<.001), illicit drug use (10.1% vs. 2.5%; P<.001) and poor performance status (13.4% vs. 7.6%; P=.010). White patients had higher had higher prevalence of respiratory disease (48.4% vs. 28.5%; P<.001).
Nonreceipt of surgery rates were higher among black patients with mild (31% vs. 22%), moderate (42% vs. 26%) and severe comorbidities (56% vs. 45%), researchers reported.
However, the effect most individual comorbidities had on receipt of surgery was similar between the two patient groups, and multivariable analysis showed comorbidities did not influence the race–surgery association, researchers wrote.
After controlling for overall comorbidity, age, marital status and poor performance status, results showed black patients were less likely than white patients to undergo surgery (OR=0.63; 95% CI, 0.46-0.87).
“Comorbidities alone do not explain the lower rates of surgical resection among blacks,” Williams and colleagues wrote. “Reasons for undertreatment require further investigation to reduce this disparity in the quality of care.”
The proportion of patients who refused surgery was higher among blacks with all levels of comorbidity: no comorbidities (14% vs. 0), mild (37% vs. 23%), moderate (32% vs. 19%) and severe (31% vs. 13%).
“This warrants further investigation to help identify target areas for extensive monitoring, treatment and control of lung cancer comorbidities in an effort to increase the likelihood of surgery,” the researchers wrote.
Click Here to Manage Email Alerts