Disparities in lung cancer treatment show no signs of resolving in US

NEW YORK (Reuters Health) - African-American patients with non-small cell lung cancer (NSCLC) were no more likely to receive optimal care in 2002 than they were in the early 1990s, according to investigators at the University of Texas in Houston.

The researchers also found that older patients, women, and people with low income also remained at greater risk of not receiving recommended treatment than their counterparts.

By linking the Surveillance, Epidemiology and End Results (SEER) and Medicare databases, Dr. Dale Hardy and colleagues identified close to 71,000 patients aged 65 and older diagnosed with stages I-IV NSCLC between 1991 and 2002. Nearly 10% were black and the remainder were white.

For stages I and II NSCLC, blacks were 37% less likely than whites to undergo surgery and 42% less likely to receive chemotherapy, after controlling for sociodemographics, comorbidity, and other cancer treatments. For later stages, black patients were 57% less likely to receive chemotherapy.

"Trends in racial disparities in treatments were not significantly decreased over time from 1991-2002," Dr. Hardy and associates write in the May 15 issue of Cancer.

Patients in the lowest quartile of socioeconomic status were significantly less likely to receive surgery (adjusted odds ratio 0.68) or chemotherapy (OR 0.85 for stages I-II and 0.60 for stages III-IV) compared with the highest quartile.

Women were less likely than men to receive chemotherapy at any stage (OR 0.54-0.72).

Patients ages 75-79 were only about half as likely to undergo surgery or chemotherapy compared with those ages 65-69. Those over 85 years of age were 90% less likely to have surgery, and about 80% less likely to receive chemotherapy.

Regarding the disparities between blacks and whites, the investigators write: "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."

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.