Study Finds Racial Disparities in ES-NSCLC Persist Despite Gains in Treatment

A study published in the Journal of Surgical Oncology suggested that improvements in the delivery of surgery and equal utilization of definitive radiation therapy are at least partially responsible for closing the survival gap between African American and Caucasian patients with early-stage non-small cell lung cancer (ES-NSCLC).¹

However, though Black patients are now more likely to receive the most effective treatment compared to a decade ago, the disparity for this patient population persists.

“We wanted to take a closer look at surgery – the most effective therapy – and how the 2 other second-line treatment options might affect the disparities in long-term outcomes across populations,” senior author Olugbenga Okusanya, MD, an assistant professor of Surgery at Thomas Jefferson University and researcher at the Sidney Kimmel Cancer Center – Jefferson Health, said in a press release.² “There has been concern that these second-line treatments have been contributing to the disparity in outcomes.”

The most effective treatment for ES-NSCLC is surgery to remove a portion of lung. However, 2 types of radiation therapy are also used as a second-line therapy, with stereotactic ablative radiotherapy (SABR) shown to be more effective than external beam radiation therapy (EBRT) for early-stage disease.

Using the National Cancer Database, researchers queried for African American and Caucasian patients diagnosed with clinical stage I NSCLC between 2004 and 2015. Trends in surgery, SABR, or EBRT were then compared using Kaplan-Meier and Cox hazards models. Overall, 174,338 (90.6%) patients identified were Caucasian and 18,077 (9.4%) were African American.

“Few reports have included this many patients and looked at both surgery and radiation therapy,” Okusanya noted.

African American patients were found to be less likely to receive surgery (60.3% vs. 66.9%; P < .001) and more likely to receive EBRT (12.4% vs. 10.6%; P < .001); however, there was no significant difference in rates of SABR (8.8% vs. 9.2%; P = .066). Importantly, from 2004 to 2015, the surgery rates increased for African American patients from 44.4% to 61.8% and for Caucasian patients from 57.6% to 65.6%.

Even with the increase observed in surgery rates, African American patients had worse 5-year overall survival on an unadjusted analysis (46.7% vs. 47.9%; P = .009). Ultimately though, when adjusted for definitive treatment, African American patients did have improved survival (HR, 0.97; 95% CI, 0.94-0.99).

Of note, other studies have suggested that comorbidities in Black patients were one of the drivers for worse outcomes, rather than the utilization of surgery.

“In contrast, we found that when Black patients get surgery there is actually a trend for them to have better survival than their white counterparts,” Okusanya said.

“We need to continue to reduce barriers to successful treatments for Black cancer patients,” added Okusanya. “We know these disparities exist across cancer types and treatments and understanding some of the drivers of these inequities is key to fixing them.”

References:

1. Lutfi W, Martinez-Meehan D, Sultan I, et al. Racial disparities in local therapy for early stage non‐small‐cell lung cancer. Journal of Surgical Oncology. doi: 10.1002/jso.26206

2. Racial Disparities in Treatment for Common Lung Cancer Persist Despite Gains [news release]. Philadelphia. Published October 28, 2020. Accessed November 19, 2020. https://www.newswise.com/articles/racial-disparities-in-treatment-for-common-lung-cancer-persist-despite-gains?sc=dwhr&xy=10019792