Black Patients Face Persistent Treatment Gaps in Early-Stage Lung Cancer

A new study finds Black Medicare beneficiaries with early-stage non–small cell lung cancer (NSCLC) continues to receive curative treatment at lower rates than White patients, highlighting ongoing barriers to care in the United States, according to study findings published in JAMA Network Open.

Researchers analyzed data from the Surveillance, Epidemiology and End Results (SEER)–Medicare program to examine trends in treatment from 2005 to 2019.

“The past 30 years have seen tremendous progress in our fundamental understanding of lung cancer and the development of new treatment strategies,” Dr. Cary Gross, professor of medicine (general medicine) at Yale School of Medicine (YSM) and senior author of the study, said in an article from Yale School of Medicine. “As treatment options have expanded, understanding how these advances are implemented across patient populations has become increasingly important.”

Main data that support the findings

Among 28,287 patients aged 66 to 85 diagnosed with stage 1 or 2 NSCLC, 82.3% received curative therapy, which includes surgery or radiotherapy. Across all three time periods, Black patients were less likely than White patients to receive curative treatment. From 2005 to 2007, 73.9% of Black patients received curative therapy compared with 83.3% of White patients, a difference of 9.4 %. From 2011 to 2013, 76.3 % of Black patients received curative treatment versus 85.2 % of White patients, and from 2017 to 2019, 78.4 % of Black patients received treatment compared with 86.8 % of White patients. These differences persisted even after adjusting for demographic and clinical characteristics.

The disparity was most pronounced for surgical treatment. In 2005 to 2007, 52.3 % of Black patients underwent surgery compared with 65.9 % of White patients. From 2017 to 2019, surgery rates were 43.7 % for Black patients and 53.1 % for White patients. Use of radiotherapy increased over time, with smaller racial differences. Stereotactic body radiotherapy (SBRT), a newer form of radiation, initially showed racial disparities when introduced, with 39.6 % of Black patients receiving SBRT from 2011 to 2013 compared with 51.6 % of White patients. By 2017 to 2019, SBRT use had increased overall, and differences between Black and White patients were no longer statistically significant.

“There’s been a lot of increased attention to disparities in cancer care over the past 20 or 30 years,” Dr. Olivia Lynch, a postdoctoral research fellow in YSM’s National Clinician Scholars Program and first author of the study, said in the article. “Given that, we wanted to ask: Have there been improvements in which patient populations receive treatment?”

Trial details

The study included 28,287 non-Hispanic Black and White Medicare beneficiaries diagnosed with stage 1 or 2 NSCLC in 17 SEER regions during three periods: 2005-2007, 2011-2013, and 2017-2019. Patients were required to have continuous Medicare fee-for-service and Part B coverage. Researchers examined receipt of any curative treatment, receipt of surgery or radiotherapy, and receipt of preferred treatments: lobectomy for surgery and SBRT for radiotherapy. Statistical models accounted for age, sex, marital status, urban residence, cancer stage, comorbidities, frailty, prior healthcare use, and influenza vaccination status.

Safety

The study did not report new safety findings or side effects, as it focused on treatment receipt and racial disparities rather than treatment outcomes. Curative treatments included surgery, which carries typical surgical risks, and radiotherapy, including SBRT, which is generally less invasive and associated with lower rates of immediate complications than surgery.

References

1. “Racial disparities in the receipt of curative treatment for early-stage non–small cell lung cancer among Medicare beneficiaries” by Dr. J. D. Ramsey, et al., JAMA Network Open
2. “Gaps in Lung Cancer Treatment Persist, Yale Study Finds.” https://medicine.yale.edu/news-article/gaps-in-lung-cancer-treatment-persist-yale-study-finds/

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

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