Abstract
Introduction
We sought to determine if increased use of stereotactic body radiation therapy (SBRT)
was associated with decreased disparities in the receipt of definitive treatment for
early-stage non-small cell lung cancer (NSCLC).
Methods
The National Cancer Database (NCDB) was utilized to determine the proportion of patients
with NSCLC receiving surgery, SBRT, or no definitive treatment for clinical cT1-2aN0M0
NSCLC from 2004-2017. Univariable and multivariable logistic regressions were used.
Age-adjusted mortality rates were calculated using the Surveillance, Epidemiology,
and End Result (SEER) database.
Results
From 2004 to 2017, the proportion of early-stage NSCLC undergoing no definitive treatment
declined from 22% to 10.5% (P<.001), while the proportion receiving SBRT increased from 1% (0.9%-1.3%) to 22% (21.4%-22.3%;
P<.001). Among Whites, the proportion undergoing no definitive treatment decreased from
21% to 10% (P<.001), as compared to Blacks, which had a higher decrease, of 32% to 15% (P<.001). The proportion of Blacks receiving SBRT increased from 1% (0.3%-1.7%) to 22% (20.8%-23.5%)
(P<.001). Between 2011 and 2017 likelihood of Blacksreceiving curative therapy increased
compared to Whites [OR: 0.55 (0.48-0.64) to 0.70 (0.62-0.79; P<.001]. Furthermore, the age-adjusted mortality rate of early-stage NSCLC decreased from
4.3 (4.0-4.5) in 2004 to 0.8 (0.7-0.9) in 2017 (P<.001).
Conclusions
Increased utilization of SBRT significantly increased the proportion of patients receiving
curative therapy for early-stage NSCLC and was associated with an improvement in mortality.
Furthermore, the use of SBRT reduced previously seen disparities in receipt of treatment
between Whites and Blacks. SBRT was also associated with decreased mortality from
early-stage NSCLC.
Keywords
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References
- Racial Differences in the Treatment of Early-Stage Lung Cancer.N Engl J Med. 1999; 341: 1198-1205https://doi.org/10.1056/NEJM199910143411606
- Disparities in Lung Cancer Treatment.Curr Oncol Rep. 2022; 24: 241-248https://doi.org/10.1007/s11912-022-01193-4
- Disparities in Receiving Guideline-Concordant Treatment for Lung Cancer in the United States.Ann Am Thorac Soc. 2020; 17: 186-194https://doi.org/10.1513/AnnalsATS.201901-094OC
- Practical Guide to Surgical Data Sets: National Cancer Database (NCDB).JAMA Surg. 2018; 153: 850https://doi.org/10.1001/jamasurg.2018.0492
- The Effect of Advances in Lung-Cancer Treatment on Population Mortality.N Engl J Med. 2020; 383: 640-649https://doi.org/10.1056/NEJMoa1916623
- Lung Cancer Screening: Review and 2021 Update.Curr Pulmonol Rep. 2022; 11: 15-28https://doi.org/10.1007/s13665-021-00283-1
- Systemic Therapy for Locally Advanced and Metastatic Non–Small Cell Lung Cancer: A Review.JAMA. 2019; 322: 764https://doi.org/10.1001/jama.2019.11058
- Recent advances in the management of lung cancer.Clin Med Lond Engl. 2018; 18: s41-s46https://doi.org/10.7861/clinmedicine.18-2-s41
- Natural History of Stage I Non-Small Cell Lung Cancer.Chest. 2007; 132: 193-199https://doi.org/10.1378/chest.06-3096
- How Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study.J Prim Care Community Health. 2017; 8: 169-175https://doi.org/10.1177/2150131917697439
Griffith K, Evans L, Bor J. The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access. Health Aff (Millwood). 2017;36(8):1503-1510. 10.1377/hlthaff.2017.0083
- Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging.Front Public Health. 2020; 8: 231https://doi.org/10.3389/fpubh.2020.00231
- COVID-19, and the South: Considerations and Recommendations.OMEGA - J Death Dying. July 1, 2021; (Published online003022282110295)https://doi.org/10.1177/00302228211029500
- Strengths and limitations of large databases in lung cancer radiation oncology research.Transl Lung Cancer Res. 2019; 8: S172-S183https://doi.org/10.21037/tlcr.2019.05.06
- Participation in Cancer Clinical Trials: Race-, Sex-, and Age-Based Disparities.JAMA. 2004; 291: 2720https://doi.org/10.1001/jama.291.22.2720
- Association of Patient Comorbid Conditions With Cancer Clinical Trial Participation.JAMA Oncol. 2019; 5: 326https://doi.org/10.1001/jamaoncol.2018.5953
Article Info
Publication History
Published online: September 23, 2022
Accepted:
September 18,
2022
Received in revised form:
August 30,
2022
Received:
June 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
