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Surgery for NSCLC varies significantly by race, geographic locations
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The receipt of curative surgery for early-stage non–small cell lung cancer varied substantially across U.S. regions, according to study results presented at the American Association for Cancer Research’s conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Specifically, greater racial disparities and lower treatment receipt generally occurred in southern states.
“We do not have a uniform quality of health care in this country,” Helmneh M. Sineshaw, MD, MPH, senior epidemiologist and health service researcher at the American Cancer Society, said in a press release. “Curative surgery for NSCLC is one example, with disparities in health care across population subgroups.”
Although previous studies have quantified racial and socioeconomic disparities in the receipt of surgery for NSCLC in the U.S., little research has addressed these disparities across states, according to study background.
Sineshaw and colleagues identified patients with invasive stage I and stage II NSCLC using the North American Association of Central Cancer Registries. They calculated percentages for the receipt of curative surgery for non-Hispanic white and non-Hispanic black patients in each state.
The researchers used non-Hispanic whites and the state of Massachusetts as comparison references.
Sineshaw and colleagues observed that receipt of curative surgery for early-stage NSCLC for white and black patients varied greatly by state. Rates of receipt varied from 55.5% in Louisiana to 76.3% in New Jersey for white patients, and 48% in Louisiana to 72.3% in Massachusetts for black patients. Patients in Massachusetts, New Jersey and Utah had the highest receipt of surgery (each approximately 75%).
These variations persisted after adjustment for demographic (eg, age, sex, diagnosis year) and clinical factors (eg, grade, stage, tumor size), although the researchers reported that statistical significance varied by state.
Compared with white patients in Massachusetts, receipt of surgery for white patients ranged from 6% less likely for patients in California (RR = 0.94; 95% CI, 0.89-0.98) to 26% less likely in Wyoming (RR = 0.74; 95% CI, 0.58-0.94).
Black patients were 21% less likely to be treated surgically in Louisiana compared with black patients in Massachusetts (RR = 0.79; 95% CI, 0.62-0.99).
Other large gaps were observed in Oklahoma (20% less likely), New Mexico (19%), Colorado (17%) and Texas (16%).
In certain states, further adjustment for insurance, census tract-level poverty and county-level metro status significantly reduced the difference in the likelihood of surgery.
Sineshaw identified the lack of information on patient/physician communication, as well as the inability to control for comorbidity, as study limitations.
“From state to state, the quality of insurance coverage may be different, even as we move toward universal health care,” Sineshaw said. “Varying standards for copays, for example, can all add up and make a difference in the cost of treatment.” – by Cameron Kelsall
Reference:
Sineshaw HM, et al. Abstract C81. Presented at: AACR conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov. 13-16, 2015; Atlanta.
Disclosure: The study was funded by the ACS. Sineshaw reports no relevant financial disclosures.