Racial disparities in treatment for common lung cancer persist despite gains

October 28, 2020

PHILADELPHIA -- Lung cancer continues to be the most deadly solid cancer in the world, despite the fact that survival rates have been improving over the past decade. However, African American patients have worse outcomes and shorter lifespans after being diagnosed with lung cancer. A new study examines more recent data, and shows that although Black patients are now more likely to receive the most effective treatment than a decade ago, the disparity persists.

"We wanted to take a closer look at surgery - the most effective therapy - and how the two other second-line treatment options might affect the disparities in long-term outcomes across populations," says senior author Olugbenga Okusanya, MD, an Assistant Professor of Surgery at Thomas Jefferson University and researcher at the Sidney Kimmel Cancer Center - Jefferson Health. "There has been concern that these second-line treatments have been contributing to the disparity in outcomes."

The results were published in the Journal of Surgical Oncology.

The most effective treatment for early stage non-small cell lung cancer is surgery to remove a portion of lung. However two types of radiation therapy are also used as a second-line therapy, with stereotactic ablative radiotherapy (SABR) shown to be more effective than external beam radiation therapy (EBRT) for early stage disease.

The researchers examined data from 192,415 patients in the National Cancer Data Base who were diagnosed with early-stage (stage 1) non-small cell lung cancer between 2004 and 2015. Of these patients, 91% were white and 9% were Black. "Few reports have included this many patients and looked at both surgery and radiation therapy," says Dr. Okusanya.

The biggest disparity was in the use of surgery, which is the most effective form of therapy for early-stage lung cancer, a difference that persisted in every year of the 11-year study period. Of note, although the utilization of surgery increased over time for both white and Black patients, the rate of increase in Black patients was faster than in white patients. "This indicates that some work is being done to close the disparity in the utilization of surgery in Black patients," says Dr. Okusanya.

Dr. Okusanya and colleagues showed that the use of SABR increased from 2004 to 2015, and the rate of EBRT decreased, as expected, based on reports that EBRT was less effective for these patients. There was no disparity across racial groups in these two second-line therapies.

"Lung cancer incidence and mortality in the Greater Philadelphia region is profound--far outstripping national averages. Studies such as these are critical for understanding factors that contribute to cancer disparities, and are part of the Sidney Kimmel Cancer Center's overarching mission to improve the lives of all cancer patients and their families," said Dr. Karen E. Knudsen, executive vice president of oncology services for Jefferson Health and enterprise director of the Sidney Kimmel Cancer Center - Jefferson Health. "Variances in care across demographics are simply unacceptable. Raising awareness to this issue through Dr. Okusanya's work is the first step toward meaningful change."

In addition, other studies have suggested that comorbidities in Black patients were one of the drivers for worse outcomes, rather than the utilization of surgery. "In contrast, we found that when Black patients get surgery there is actually a trend for them to have better survival than their white counterparts," says Dr. Okusanya.

"We need to continue to reduce barriers to successful treatments for Black cancer patients," says Dr. Okusanya. "We know these disparities exist across cancer types and treatments and understanding some of the drivers of these inequities is key to fixing them."
The authors declare no conflict of interests.

Article reference:
Waseem Lutfi, Deirdre Martinez-Meehan, Ibrahim Sultan, Nathaniel Evans III3, Rajeev Dhupar, James D. Luketich, Neil A. Christie, Olugbenga T. Okusanya, "Racial disparities in local therapy for early stage non?small?cell lung cancer," J Surg. Oncol, DOI: 10.1002/jso.26206, 2020.

Media contact:
Edyta Zielinska

Thomas Jefferson University

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.