The effect of race on recommendation and acceptance of surgical resection for non-metastatic non-small cell lung cancer (NSCLC)

Abstract

6018 Background: Black patients with early stage NSCLC have previously been found to have worse overall survival than White patients. Decreased likelihood to undergo resection has been implicated. To isolate the effect of decision-making from access to care, we used receipt of recommended surgical staging as a proxy for access, and examined treatment patterns and outcomes. Methods: We examined registry and claims data of Medicare-eligible patients with non-metastatic NSCLC living in areas monitored by the Surveillance, Epidemiology, and End Results (SEER) program between 1991–1996. Surgical staging was defined as bronchoscopy, mediastinoscopy, or thoracoscopy. We used logistic regression and Cox modeling to calculate the odds of having surgical staging, resection, and survival outcomes. Results: Among 23,943 patients, 15,162 underwent surgical staging and 7,014 had a resection. Survival for Black patients was worse than Whites (HR 1.08, P<0.0009). Black patients were less likely to undergo surgical staging (Odds Ratio (OR) 0.84, 95% Confidence Interval (CI) 0.76–0.93) or resection (OR 0.55, CI 0.49–0.62). Black patients once staged were still less likely to have a resection (OR 0.60, CI 0.53–0.69). Survival for Blacks and Whites was equivalent after resection. In patients who were staged but did not have surgery, Black patients had better overall survival when compared to Whites (40% vs. 37.7% at 1 year, 16.8% vs. 15.8% at 2 years, HR 0.92, P<0.028). Black patients who had surgical staging were less likely to have resection recommended (44.6% vs.56.4 %), but twice as likely to decline resection. (3.2% vs. 1.4%) Conclusions: Finding that Black patients who were surgically staged but did not have resection had a superior survival to White counterparts suggests that there are Black patients who may benefit from resection who are not receiving it. Barriers to resection may include Black patients being less likely to be offered resection in borderline cases, or being less accepting of recommendations for resection. Further examination of patient and provider attitudinal determinants is needed. No significant financial relationships to disclose.