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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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3055 — Treatment and survival disparities among veterans with early-stage lung cancer

Williams CD, Durham VAMC; Kelley MJ, Durham VAMC;

Objectives:
To utilize a decade of data to evaluate trends in receipt of treatment among blacks and whites and examine the impact of race on survival outcomes.

Methods:
We used data from a national cohort of patients in the Veterans Administration diagnosed with Stage I/II non-small cell lung cancer (NSCLC) between 2001 and 2010. Chi-square statistics were used to compare treatment and outcomes by race. Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (95%CI).

Results:
Among 18,442 patients with stage I/II NSCLC, the proportion of blacks and whites receiving surgery was 54% and 59% (p ? 0.0001), respectively. The black-white difference in surgery rates was 8% in 2001 and 1% in 2010. There was no racial difference in receipt of nonsurgical therapy; however, blacks were more likely than whites to have no treatment (22% vs. 18%, p ? 0.0001). Among surgical patients, type of surgical resection was similar by race, the 30-day mortality rate was 2% in both race groups, but 90-day mortality was significantly higher in whites than blacks (6% vs. 3%, p = 0.0008). There was no racial difference in type of nonsurgical treatment, with 86% of all patients who did not have surgery receiving radiation therapy. Among all patients, the 4-year survival rate was 40% in blacks and 39% in whites (p = 0.38), and the adjusted HR for blacks compared to whites was 0.91 (95%CI 0.84-0.98). Statistically significant HRs less than one for blacks were also observed within each treatment group.

Implications:
Racial differences in surgical treatment decreased between 2001 and 2010. Despite overall lower surgery rates among blacks, the proportion of black and white patients surviving 4 years was similar although overall survival was slightly better among blacks, and this finding was consistent among patients with and without treatment

Impacts:
The racial disparity in receipt of surgery for early-stage lung cancer decreased, with similar rates observed at the end of the study period. Previously reported racial differences in survival outcomes were not observed in this cohort.