Early Lung Cancer Treatment Affected by Race, Insurance Status

Study finds African Americans and Hispanics significantly less likely to be treated with radiation.

The race and insurance status of patients plays a significant role in the likelihood of them receiving early treatment for early stage lung cancer, according to the results of a recent study.

In a study published in the Journal of Thoracic Oncology, researchers found that African Americans, Hispanics, and patients treated at a community hospital, are all drastically less likely to receive treatment for early stage non-small cell lung cancer (NSCLC) than other patients.

The study analyzed early treatment patterns for patients with stage I NSCLC, at which point early treatment offers the best chance for long-term survival.

"We found significant disparities for treatment of a curable cancer based on race, insurance status, and whether or not treatment was at an academic or community hospital," said lead author Matthew Koshy, MD, in a press release. "Reducing these disparities could lead to significant improvements in survival for many people with inoperable early stage lung cancer."

Numerous patients unable to undergo surgery to remove cancerous nodules in the lungs due to complicating medical conditions receive radiation therapy as the standard treatment. With only minimal benefits provided by conventional radiation, outcomes are much poorer than those from surgical treatment.

Researchers sought to determine whether any factors predicted if a patient was more likely to be observed, treated with conventional radiation, or treated with stereotactic body radiotherapy (SBRT), which has replaced conventional radiation as the standard treatment for inoperable stage I NSCLC. They also examined possible disparities in the use of those therapies.

The study utilized data from approximately 40,000 patients with inoperable stage I NSCLC between 2003 and 2011, including information on patient demographics, insurance status, diagnosis, treatment, and outcome.

The researchers found that African Americans were 40% less likely to be treated with SBRT or conventional radiation, while Hispanics were 60% less likely to be treated with SBRT or conventional radiation. In patients that were treated with radiation, African Americans and the uninsured were less likely to receive SBRT.

Patients treated in academic hospitals were 2-and-a-half times more likely to receive SBRT than those treated in community hospitals. Additionally, patients were 7 times more likely to receive SBRT at a high-volume medical center than in low-volume centers.

In 2011 alone, 46% of patients treated in community care centers were only observed, compared with 21% of patients at academic medical centers. Meanwhile, 68% of patients treated at academic medical centers received SBRT, compared with 25% of patients treated at community hospitals.

As a result, the researchers suggest all patients with early stage inoperable lung cancer be evaluated by a radiation oncologist.

“Better access to facilities that offer SBRT could help reduce the disparities the study uncovered,” Dr. Koshy said.