Surgical Treatment for Early Stage NSCLC Differs by Race

CHICAGO—A national study of nearly 11,000 patients confirmed what previous regional studies have suggested: Black Americans are less likely than whites to undergo surgery for early stage non-small-cell lung cancer (NSCLC).

The variation in treatment may explain some of the differences in survival that have been observed between blacks and whites, and it indicates that physicians may be able to improve survival of black patients by increasing their rates of surgical therapy, health services researcher Peter Bach, MD, said at the Second Annual Cancer Care Symposium sponsored by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and others.

Study Results

Dr. Bach and his colleagues at Memorial Sloan-Kettering Cancer Center evaluated the care given to 10,984 Medicare patients identified as having stage I or II NSCLC in the Surveillance Epidemiology and End Results (SEER) database between 1985 and 1993. Analysis of data from this review concluded that race was associated with treatment for early stage NSCLC.

There was a 12.7% absolute difference in the rate of surgery between whites and blacks; a total of 76.7% of white patients had surgery, compared with 64% of black patients. The likelihood that a black patient would have surgery vs a white patient was 0.83, and the odds ratio for a black patient to have surgery, compared with a white patient, was 0.51.

This disparity translated into higher overall mortality for blacks. Overall 5-year survival for the patients in the study was 34% for white patients and 26% for black patients.

There was no statistically significant difference in survival when patients had the same treatment. For patients having surgery, the 5-year survival rate was 43% for white patients and 39% for black patients. White patients who did not undergo surgery had a 5% survival rate at 5 years, compared with 4% for black patients who had nonsurgical care.

“Although there is a large overall difference in survival, there is no apparent survival difference based on treatment. This is good evidence that race does not affect treatment outcome,” he said.