Racial Differences in Toxicity in Non-Small Cell Lung Cancer Patients Treated with Thoracic Radiotherapy

Abstract

Racial disparities are of particular concern for lung cancer patients given historical discrepancies in surgery rates for Black lung cancer patients that resulted in lower survival and higher recurrence rates for Black patients. The goal of this study was to examine racial differences in thoracic radiotherapy (RT) treatments and toxicities in non-small cell lung cancer (NSCLC) patients. A large multi-institutional statewide prospectively collected patient-level database of Stage II-III NSCLC patients who received thoracic RT from Mar 2012 to Nov 2019 was queried to assess relationships between race and other variables. Race (White or Black) was defined by patient self-report. Race other than White or Black comprised a small minority of patients (n = 46) and was excluded. Provider reported toxicity was defined by the Common Terminology Criteria for Adverse Events v5.0. Patient reported toxicity was determined by validated questionnaires. Multilevel logistic modeling and t-tests were performed to assess relationships between race and other variables. 1441 patients from 24 institutions with mean age of 68 years (range 38 – 99) were evaluated; 226 patients were Black, of whom 61% were treated at 3 facilities. Race was not significantly associated with RT treatment approach, concurrent chemotherapy use, or dose to organs at risk or PTV. There was increased patient reported general pain in Black patients at the end of RT (p = 0.004, see Table 1) but no other patient reported toxicities were significantly different by race. Black patients were significantly less likely to have provider reported grade 2+ pneumonitis (odds ratio (OR) 0.36, p = 0.03), even after controlling for many patient and treatment factors. A trend towards increased provider reported grade 2+ esophagitis in Black patients was also observed (OR 1.51, p = 0.06). In this large multi-institutional study, we reassuringly found no evidence of differences in RT treatment or chemotherapy approaches by race. We did, however, detect racial differences in patient and provider reported toxicities that has motivated a formal concordance analysis currently in progress. These relationships are multi-factorial and causality cannot be determined from our observational database; however, the findings may have implications for the care of racially diverse patients and warrants further research.Abstract 2329; TablePatient and provider reported toxicities (all in %)TimepointPre-RTEnd of RT3 months post-RTRaceWhiteBlackWhiteBlackWhiteBlackPatient Reported Bother Score 3+ Toxicity (%)Side Effects (general)462121710Cough302624272117Shortness of Breath252619172118Chest Pain97101367General Pain152217*30*1011Trouble Swallowing10.4540.30.9Provider Reported Grade 2+ Pneumonitis (%)0.700.40.574Provider Reported Grade 2+ Esophagitis (%)23333530Note: *t-test p-value = 0.004. Open table in a new tab