Racial Disparities in Treatment and Outcome of Non-Small Cell Lung Cancer (NSCLC) Patients Across Different Facility Types

Abstract

<h3>Purpose/Objective(s)</h3> We hypothesize that differential disparities exist in diagnosis, treatment and outcome among NSCLC patients of different races across different types and locations of treatment facilities. <h3>Materials/Methods</h3> The National Cancer Database was queried for cases of lung cancer from 2004-2016. Patients with invasive lung cancer were included. Exclusion criteria were unknown treatment status and unknown tumor size. Multivariate logistic and Cox model were used to assess effects of age, sex, race, facility type, facility location, insurance, education and income on stage, receipt of any treatment, time to receive treatment and outcome. <h3>Results</h3> Among 457,236 patients, 149,772 (32.8%), 241,471(52.9%) and 65,330 (14.3%) were treated at academic, community and integrated centers, respectively. After adjusting for co-founders, as shown in Table 1, Black (B) and Asian (A) race was associated with later stage but better outcomes. B race was associated with less treatment and delayed treatment. In academic facilities, B and A race had later stage, less and delayed treatment but better outcomes. In integrated facilities, B race had similar outcome as White (W) race. When compared to patients from Central facility location, those from West Coast and Mountain facility locations received less treatment (OR, 0.70 and 0.78, respectively, <i>P</i> < 0.001) and later treatment (HR, 0.83 and 0.91, respectively, <i>P</i> < 0.001); patients from Mountain facility locations had better outcomes (HR, 0.89, <i>P</i> < 0.001). <h3>Conclusion</h3> B and A patients were diagnosed at later stage and had less and delayed treatment. However, they had better outcomes stage for stage when compared to W patients. The reverse racial disparity between B and W patients was less in integrated facilities. Efforts to investigate these reverse racial disparities are warranted. Patients from Mountain facility locations had better outcomes than those from Central facility locations, despite less and later treatment. Investigation regarding the effects of facility location on outcome is warranted.