Racial Disparities in Cancer Guideline-Concordant Treatment Using Surveillance, Epidemiology, and End Results Data for Patients With NSCLC

Abstract

Introduction

Despite efforts to achieve health care equality, racial/ethnic disparities persist in lung cancer survival in the United States, with non-Hispanic Black patients experiencing higher mortality compared with non-Hispanic Whites. Previous research often focused on single treatments, overlooking the broad range of options available. We aimed to highlight disparities in survival and receipt of comprehensive lung cancer treatment by developing a guideline-concordant initial treatment (GCIT) indicator based on disease stage and recommended treatment.

Methods

Using data of the Surveillance, Epidemiology, and End Results on 377,370 patients with NSCLC, we derived a GCIT indicator based on National Comprehensive Cancer Network guidelines. Observed probabilities and logistic regression models adjusted for age, disease stage, and race were used to assess racial disparities in treatment and survival, with the Kaplan-Meier method evaluating survival rates. Racial/ethnic groups analyzed included non-Hispanic White, non-Hispanic Black, Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native.

Results

Non-Hispanic Black patients had lower odds of receiving GCIT (OR = 0.80; 95% confidence interval [CI]: 0.78–0.82) and surviving 2 years after diagnosis (OR = 0.80; 95% CI: 0.78–0.82). Non-Hispanic Asians had the highest odds of receiving GCIT (OR = 1.02; 95% CI: 0.99–1.05). Patients receiving GCIT had improved survival, with early stage patients experiencing median survival of 67 to 102 months, compared with 11 to 17 months for those without GCIT.

Conclusion

Receiving GCIT considerably improves survival across all races, though disparities in receipt are observed. Interventions are needed to ensure equitable access to guideline-concordant care and reduce survival disparities for patients.