Affiliation:
1. 1Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.
2. 2Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida.
3. 3Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida.
Abstract
Abstract
Background:
Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non–small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort.
Methods:
Early-stage NSCLC cases (2005–2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type.
Results:
Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014–2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60–0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60–0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93–1.20) compared with CCI = 0.
Conclusions:
Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved.
Impact:
Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients.
Funder
Bankhead-Coley Foundation
Publisher
American Association for Cancer Research (AACR)
Reference57 articles.
1. Update of incidence, prevalence, survival, and initial treatment in patients with non-small cell lung cancer in the US;Ganti;JAMA Oncol,2021
2. Cancer statistics, 2022;Siegel;CA Cancer J Clin,2022
3. Association of stage shift and population mortality among patients with non-small cell lung cancer;Flores;JAMA Netw Open,2021
4. Non-small cell lung cancer, version 5.2017, NCCN clinical practice guidelines in oncology;Ettinger;J Natl Compr Canc Netw,2017
5. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines;Howington;Chest,2013
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