Racial, socioeconomic disparities in extensive-stage small cell lung cancer treatment

October 26, 2020

BOSTON - A new study shows that Black individuals with extensive-stage small cell lung cancer are less likely to receive chemotherapy for their disease compared to white and other racial groups. Led by researchers at Boston Medical Center, the results indicate that individuals who are Black, elderly, uninsured, or have non-private health insurance and lower education levels, were less likely to be treated with chemotherapy for this type of lung cancer. Published in , the official journal of the International Association for the Study of Lung Cancer, this study is one of the largest to investigate the racial and health disparities in treating patients with extensive-stage small cell lung cancer, and highlights the impact that race and insurance status have on cancer care in the U.S.

Given the tendency of this type of lung cancer to rapidly progress, current recommendations and practices favor starting treatment as soon as possible after a patient is diagnosed with extensive-stage small cell lung cancer (ES-SCLC). Analyzing the National Cancer Database (NCDB) between the years 2004 and 2016, researchers discovered that Black patients had lower odds of receiving chemotherapy compared to white patients, but had improved survival, with the median survival of 8.3 months compared to eight months. This is an unexpected finding given that the disease is highly sensitive to chemotherapy, and this treatment is the most important predictor of survival.

"Our study highlights the disparities that can exist in healthcare, and the impact that race and socioeconomic status can have on a patient's experience throughout their treatment," says Umit Tapan, MD, a thoracic oncologist at Boston Medical Center and the study's corresponding author.

In this large-scale analysis, racial and socioeconomic factors impacting systemic therapy delivery and survival in ES-SCLC were identified through a total of 82,592 ES-SCLC patients between 2004 and 2016, as identified through the NCDB. The analysis showed that chemotherapy was administered to 92.1 percent of patients. Insurance and income status played a large role in treatment and survival of patients. Black patients were more likely to be uninsured or have public health insurance compared to white and other race groups, and patients with non-private insurance or without insurance were less likely to receive chemotherapy treatment. Private insurance was associated with the highest survival of 9.2 months, followed by patients with Medicaid at 8.3 months. Lower income is associated with worse survival, which has been found for all lung cancer diagnoses.

"While our study looked specifically at patients with extensive-stage small cell lung cancer, our results further demonstrate the impact that socioeconomic status can have on the health of patients, whether it be access to treatment or their outcomes," said Tapan, also an assistant professor of medicine at Boston University School of Medicine. Another important point highlighted in the study shows that Black patients had higher odds of receiving chemotherapy between 2010 and 2016 compared to 2004-2009, which the authors suggest is a positive impact of the Patient Protection and Affordable Care Act (ACA) in 2010.

Further studies are needed to address the underlying reasons for lack of chemotherapy receipt in Black patients with ES-SCLC, and to guide the appropriate interventions to mitigate these disparities.
-end-
About Boston Medical Center

Boston Medical Center (BMC) is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. BMC offers specialized care for complex health problems and is a leading research institution, receiving more than $166 million in sponsored research funding in fiscal year 2019. It is the 13th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet - 12 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit
http://www.bmc.org.

Boston Medical Center

Related Lung Cancer Articles from Brightsurf:

State-level lung cancer screening rates not aligned with lung cancer burden in the US
A new study reports that state-level lung cancer screening rates were not aligned with lung cancer burden.

The lung microbiome may affect lung cancer pathogenesis and prognosis
Enrichment of the lungs with oral commensal microbes was associated with advanced stage disease, worse prognosis, and tumor progression in patients with lung cancer, according to results from a study published in Cancer Discovery, a journal of the American Association for Cancer Research.

New analysis finds lung cancer screening reduces rates of lung cancer-specific death
Low-dose CT screening methods may prevent one death per 250 at-risk adults screened, according to a meta-analysis of eight randomized controlled clinical trials of lung cancer screening.

'Social smokers' face disproportionate risk of death from lung disease and lung cancer
'Social smokers' are more than twice as likely to die of lung disease and more than eight times as likely to die of lung cancer than non-smokers, according to research presented at the European Respiratory Society International Congress.

Lung cancer therapy may improve outcomes of metastatic brain cancer
A medication commonly used to treat non-small cell lung cancer that has spread, or metastasized, may have benefits for patients with metastatic brain cancers, suggests a new review and analysis led by researchers at St.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Lung transplant patients face elevated lung cancer risk
In an American Journal of Transplantation study, lung cancer risk was increased after lung transplantation, especially in the native (non-transplanted) lung of single lung transplant recipients.

Proposed cancer treatment may boost lung cancer stem cells, study warns
Epigenetic therapies -- targeting enzymes that alter what genes are turned on or off in a cell -- are of growing interest in the cancer field as a way of making a cancer less aggressive or less malignant.

Are you at risk for lung cancer?
This question isn't only for people who've smoked a lot.

Read More: Lung Cancer News and Lung Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.