An intervention study to reduce black-white treatment disparities in early stage non-small cell lung cancer.

Abstract

6560 Background: Racial disparities in the treatment of non-small lung cancer (NSCLC) continue to exist leading to poorer outcomes in African-Americans (AA) compared to Caucasians (C). Our previous multi-institutional prospective cohort study of 386 patients identified a surgical rate in early stage NSCLC of 66% C but only 55% AA (p = 0.05; OR 0.75; 95% CI 0.57-0.99). (Cykert et al JAMA 2010) A 3 year retrospective chart review of all patients with early stage NSCLC at the 3 academic institutions involved in this current intervention study identified 714 patients with early stage NSCLC. Baseline surgical rates 69% for C and 66% for AA. Combined stereotactic body radiation therapy (SBRT) with surgery C 80% and AA 76%. Controlling for co-morbidities, COPD, age and other demographic data, the OR for surgery AA compared to C 0.64 (95% CI 0.43-0.96) and for combined surgery or SBRT AA compared to C 0.61 (95% CI 0.43-0.96). Methods: Patients with a stage I or II NSCLC were identified and randomized to each institution’s standard of care approach or to an ‘intervention’ component utilizing a trained navigator to enhance patient communication and treatment understanding. Results: 244 patients were prospectively recruited into this intervention study. Mean age 65.7 years; 54% women; 89 (34%) AA. The intervention group showed an overall surgical rate of 74% (74.8% C, 71.4% AA; p = 0.6). Combined treatment of either surgery or SBRT increased an ablative treatment to 91.9% for C and 94.1% AA patients (p = 0.5). Logistic regression was performed comparing the intervention group to the baseline group. Results showed that overall treatment improved for both C and AA, the surgical and overall treatment disparity between C and AA was no longer present, while age, COPD, and clinical stage remained significant predictors of treatment. Conclusions: A multifaceted intervention designed to enhance patient communication and treatment understanding removed the surgical and overall early lung cancer treatment disparity between AA and C. Clinical trial information: NCT01687738.