Evaluation of the Causes for Racial Disparity in Surgical Treatment of Early Stage Lung Cancer

Abstract

Black patients undergo surgical treatment for early stage lung cancer less often than whites. We wanted to determine the causes for the racial difference in resection rates. We studied a retrospective cohort of patients who presented to our institution with potentially resectable lung cancer (stage I or II) between the years 1995 and 1998, inclusive. A tertiary-referral hospital and clinic with a cancer database of all lung cancer patients seen. A total of 281 patients were included: 97 black patients (35%) and 184 white patients (65%). The surgical rate was significantly lower in blacks than in whites (56 of 97 patients [58%] vs 137 of 184 patients [74%], p = 0.004). We could not find evidence that the rate at which surgical treatment was offered was different between the two racial groups (68 of 97 black patients [70%] and 145 of 184 white patients [79%], p = 0.11). After controlling for preoperative pulmonary function, tumor stage, history of smoking, and significant comorbidities, we were unable to show that race was a predictor of being offered surgical treatment (odds ratio, 0.46; 95% confidence interval, 0.18 to 1.14; p = 0.09). The difference in surgical rates was mainly due to the fact that blacks were found to decline surgical treatment more often than their white counterparts (12 of 68 patients [18%] vs 7 of 145 patients [5%], p = 0.002). Our analysis suggests that the lower surgical rate among black patients with early stage lung cancer is mainly due to low rates of acceptance of surgical treatment.