Health Services Research
PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): To compare patterns of care by race and ethnicity in patients with stage III non-small cell lung cancer (NSCLC) not treated surgically using the National Cancer Database (NCDB). We hypothesize that racial/ethnic minority patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT).
Materials/Methods: We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. Race groups included: white (W), black (B), and Asian-Pacific Islander (API). We also identified patients of Spanish origin (S). We categorized patients as having no treatment, palliative treatment (chemotherapy alone, radiation therapy (RT) alone<59.4 Gy or chemoradiation (CRT)<59.4 Gy), or curative treatment (RT alone≥59.4 Gy or CRT≥59.4 Gy). Patients treated with CRT were further subdivided into those receiving CCRT vs. those treated with sequential CRT (SCRT). CCRT was defined as chemotherapy delivered within 30 days prior to or after initiation of RT while SCRT was defined as RT delivered >30 days after initiation of chemotherapy. Differences in treatment patterns between W and non-W patients were tested using the χ2 test.
Results: We identified 97,147 W, 13,877 B, 2,027 API, and 2,502 S patients with stage III NSCLC not treated surgically. The proportion of patients not receiving any treatment was significantly higher for non-W vs. W (18.7%) patients: 19.4% B (p=0.0303), 21.7% API (p=0.0005), 21.7% S (p=0.0001). Curative treatment was delivered in 52.9% of W patients, which was significantly higher compared to all other groups, especially API and S patients: 51.9% B (p=0.0436), 45.8% API (p<0.0001), and 46.0% S (p<0.0001). Similarly, use of standard-of-care CCRT was also significantly lower in all groups compared to the 31.6% of W patients that received CCRT: 30.5% B (p=0.0090), 25.7% API (p<0.0001), and 24.0% S (p<0.0001).
Conclusion: In this large study of patients with stage III NSCLC not treated surgically, we identified substantial differences in treatment patterns by race/ethnicity. In particular, more than one-fifth of API and S patients do not receive any treatment for this potentially curable disease, fewer than half receive a curative treatment approach, and only ~25% of these patients receive CCRT. Further research is needed to identify causes and solutions for these disparities in care.
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