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Racial disparities observed in guideline-concordant lung cancer treatment
Only 62% of patients with lung cancer in the United States receive the minimal treatment recommended by National Comprehensive Cancer Network guidelines, according to results of a study published in Annals of the American Thoracic Society.
Further, non-Hispanic black patients and elderly patients had a lower likelihood of receiving the minimal treatment compared with non-Hispanic white and younger patients.
“Access-to-care challenges through insurance and the lack of access to high-quality cancer centers can play a role in differences in treatment,” Erik F. Blom, MD, scientific researcher in the department of public health at Erasmus MC University Medical Center Rotterdam in the Netherlands, told HemOnc Today. “Also, it may be possible that some elderly patients were too sick for treatment. However, we were able to control results in our study for several factors, including comorbidity, extent of disease, insurance, hospital type and hospital volume.”
Previous studies have indicated that not all patients with lung cancer receive the minimal treatment recommended by NCCN guidelines. Those include black and elderly patients as well as those with more advanced stages of disease.
Blom and colleagues examined adherence to guideline-concordant treatment and whether disparities by age and racial/ethnic group persist across clinical subgroups in their analysis of 441,812 cases of lung cancer diagnosed between 2010 and 2014 and included in the National Cancer Database.
Researchers used multivariable logistic regression models to assess disparities by age and racial/ethnic groups and determine whether they persist after adjustment for certain patient and tumor characteristics and health insurance status.
Results showed 62.1% of patients (range among clinical subgroups, 50.4-76.3) received guideline-concordant treatment after diagnosis of lung cancer. Additionally, 21.6% (range, 10.3-31.4) received no treatment and 16.3% (range, 6.4-21.6) received less intensive treatment than recommended.
The most common less-intensive-than-recommended treatments included conventionally fractionated radiotherapy for all subgroups (percentage range, 2.5-16), chemotherapy for nonmetastatic subgroups (percentage range, 1.2-13.7), and conventionally fractionated radiotherapy and chemotherapy for localized non-small cell lung cancer (5.9%).
Increasing age of patients correlated with lower odds of receiving guideline-concordant treatment despite adjusting for relevant covariates (age 80 years or older vs. younger than 50 years: adjusted OR [aOR] = 0.12; 95% CI, 0.12-0.13). Researchers observed this association across clinical subgroups.
They also found that, after adjusting for covariates, non-Hispanic black and Hispanic patients were less likely to receive guideline-concordant treatment than non-Hispanic whites (non-Hispanic blacks, aOR = 0.78; 95% CI, 0.76-0.8; Hispanics, aOR = 0.94; 95% CI, 0.9-0.98). This disparity existed among all clinical subgroups, although it did not reach statistical significance for extensive-disease small cell lung cancer.
The hospital-based nature of the data and lack of information on patient preferences or whether illness prevented patients from receiving more intensive cancer therapy served as the study’s primary limitations.
“Most of the literature on treatment disparities that I encountered is from the United States. However, that doesn’t mean the problem doesn’t exist in other developed countries,” Blom told HemOnc Today. “Our findings do not necessarily translate directly to other developed countries, as possible underlying reasons may vary. For example, some studies have suggested that possible underlying reasons for racial treatment disparities could be mistrust and negative beliefs toward treatment among minorities, both of which may be culturally bounded. More research is necessary to identify the possible underlying reasons for these disparities.” – by John DeRosier
For more information:
Erik F. Blom, MD, can be reached at P.O. Box 2040, 3000 CA, Rotterdam, Netherlands; email: e.f.blom@erasmusmc.nl.
Disclosures: NCI funded this study. The authors report no relevant financial disclosures.