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, Black patients have worse outcomes and shorter lifespans after being diagnosed with lung cancer. A study published in the Journal of Surgical Oncology 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.1
“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,” said senior author Olugbenga Okusanya, MD, 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.”
Olugbenga Okusanya, MD
The most effective treatment of early-stage non–small cell lung cancer (NSCLC) is surgery to remove a portion of the lung. However, two types of radiation therapy are also used as a second-line therapy, with stereotactic ablative radiotherapy shown to be more effective than external-beam radiation therapy for early-stage disease.
The researchers examined data from 192,415 patients in the National Cancer Database who were diagnosed with early-stage (stage I) NSCLC 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,” said Dr. Okusanya.
The biggest disparity was in the use of surgery, a difference that persisted in every year of the 11-year study period. Of note, although the use 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,” Dr. Okusanya noted.
Dr. Okusanya and colleagues showed that the use of stereotactic ablative radiotherapy increased from 2004 to 2015, and the rate of external-beam radiation therapy decreased, as expected, based on reports that the latter was less effective for these patients. There was no disparity across racial groups in these two second-line therapies.
“We need to continue to reduce barriers to successful treatments for Black cancer patients,” said 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.”
Disclosure: The authors reported no conflict of interests.
1. Lutfi W, Martinez-Meehan D, Sultan I, et al: Racial disparities in local therapy for early stage non–small-cell lung cancer. J Surg Oncol. September 14, 2020 (early release online).