Racial disparities observed in guideline-recommended lung cancer imaging
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Blacks and Hispanics appeared less likely than non-Hispanic whites to receive guideline-recommended PET/CT imaging at the time of lung cancer diagnosis, according to results of a study published in Journal of the National Cancer Institute.
“After reading several studies that showed minority patients with cancer experience worse outcomes, the question arose about how the imaging that patients undergo after a diagnosis may contribute to this disparity,” Rustain L. Morgan, MD, assistant professor of nuclear radiology and program director of the diagnostic residency program at University of Colorado, told Healio. “We hope our findings serve as opportunity for oncologists and health care systems to create wide initiatives that ensure all patients — regardless of their race or ethnicity — are receiving the best care possible.”
Previous studies have shown significant racial disparities associated with lung cancer treatment and outcomes.
Morgan and colleagues sought to assess the differences in initial imaging and survival among non-Hispanic white (n = 28,881), black (n = 3,123) and Hispanic (n = 1,907) adults with lung cancer. All patients were enrolled in Medicare fee-for-service and included in the SEER database between 2007 and 2015.
Comparison of PET/CT imaging use between the groups served as the primary endpoint. Cancer-specific survival at 1 year served as the secondary endpoint.
Researchers used chi-square tests and logistic regression to assess factors associated with imaging utilization. They calculated hazard ratios and survival through the Kaplan-Meier method and Cox proportional hazards regression.
Results showed that compared with whites, blacks (OR = 0.51; 95% CI, 0.44-0.6) and Hispanics (OR = 0.67; 95% CI, 0.54-0.83) with squamous cell NSCLC were less likely to receive PET imaging.
In addition, patients with non-squamous cell NSCLC appeared less likely to receive PET imaging if they were black (OR = 0.57; 95% CI 0.51-0.64) or Hispanic (OR = 0.76;95% CI, 0.67-0.88).
Researchers reported ORs for PET imaging across all histologic types of 0.54 (95% CI, 0.5-0.59) for black patients and 0.72 (95% CI, 0.65-0.81) for Hispanic patients compared with white patients.
Treatment facility type correlated with PET use, with NCI centers (OR = 3; 95% CI, 2.17-4.16) and teaching hospitals (OR = 1.22; 95% CI, 1.07-1.4) more likely to provide PET imaging. However, fewer than 10% of all patients received care at an NCI center, including 8.4% of Hispanics, 7.9% of whites and 7.4% of blacks. Teaching hospitals appeared to be the most common treatment site among blacks (56.7%) and whites (47.2%) and second most common among Hispanics (41%), about half of whom received treatment at facilities other than NCI centers or teaching hospitals.
Survival results showed the lowest risk for death among blacks (HR = 0.84; 95% CI, 0.75-0.94) after controlling for several factors, and associations between PET imaging and a lower probability for death (HR = 0.61; 95% CI, 0.57-0.65) among all patients with squamous cell carcinoma histology.
Cancer-specific survival after 1 year among those with other histologic types who received PET imaging was nearly double that of patients without PET imaging (HR = 0.62; 95% CI, 0.6-0.65).
OS at 1 year was 54.8%. When researchers combined all histologic types, the 1-year probability for survival was more than 20% higher among patients who received PET imaging compared with patients who received CT imaging alone.
Patients with squamous cell carcinoma who received PET imaging with or without CT had a lower risk for death than patients who received CT imaging alone (HR = 0.63; 95% CI, 0.59-0.67).
“We are currently working on a grant to evaluate how this issue is affecting patients with other types of cancer and a process for radiologists to help ensure patients are imaged correctly,” Morgan told Healio. – by Jennifer Southall
For more information:
Rustain L. Morgan, MD, can be reached at University of Colorado, 12401 E. 17th Ave., Mail Stop L954, Aurora, CO 80045; email: rustain.morgan@cuanschutz.edu.
Disclosures: Population Health Shared Resource funded the study. Morgan reports no relevant financial disclosures. One author reports funding by the National Institute of Dental and Craniofacial Research and clinical trial funding from AstraZeneca and Cancer League of Colorado for work unrelated to the current study.
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