3055 — Treatment and survival disparities among veterans with early-stage lung cancer
Williams CD, Durham VAMC; Kelley MJ, Durham VAMC;
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.
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).
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.
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
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.