Racial Disparities and Treatment Trends in a Large Cohort of Elderly Black and White Patients With Nonsmall Cell Lung Cancer

BACKGROUND: This study investigated whether there was a significant gap in receipt of treatment for non-small cell lung cancer (NSCLC) between blacks and whites, and whether the gap or disparity changed during the past 12 years from 1991 to 2002. METHODS: The study population consisted of 83,101 patients including 75,141 (90.4%) whites and 7960 (9.6%) blacks aged >= 65 years who were diagnosed with American Joint Committee on Cancer (AJCC) stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Results (SEER) program's Medicare database. Age-adjusted and sex-adjusted rates and crude and adjusted odds ratios for receiving appropriate stage-specific treatment of NSCLC were reported. RESULTS: For stages I-II NSCLC combined, blacks were 37% less likely (OR, 0.63; 95% confidence interval [CI], 0.550.73) to receive surgery, 42% less likely (OR, 0.58; 95% CI, 0.36-0.92) to receive chemotherapy, and for stages III-IV combined, 57% less likely (OR, 0.43; 95% CI, 0.30-0.61) to receive chemotherapy compared with whites. Older patients, women, and those in lower socioeconomic quartiles had greater disparities in receipt of treatment compared with the highest income quartile. Disparity trends were not significantly narrowed during the past 12 years between blacks and whites for receipt of the above treatments. CONCLUSIONS: There have been substantial disparities in receiving recommended treatments between blacks and whites, and these disparities have been relatively stable without a significant trend of narrowing during the past 12 years. Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment for NSCLC. Cancer 2009;115:2199-211. (C) 2009 American Cancer Society.