Racial Disparities in Surgical Treatment of Lung Cancer

Disparities in the surgical treatment of patients with lung cancer have been demonstrated, even in participants from the National Lung Screening Trial (NLST) who were considered fit to undergo thoracic surgery, according to a secondary analysis of data from the NLST.¹

The current analysis compared 3 rounds of annual screening with either low-dose computed tomography or chest radiography to prevent deaths from lung cancer in both high-risk smokers and former smokers.² Results of the present study were published in CHEST.

Investigators of the current analysis sought to explore whether racial disparities existed in black patients with early stage non-small cell lung cancer (NSCLC) and to describe surgical resection patterns in people with early stage NSCLC from the NLST. Participants from the NLST with clinical stage I NSCLC were included. Covariates were demographics, smoking history, tumor characteristics, timing of cancer detection, and presence of comorbidities. Resection rates in black vs white patients were evaluated with the use of logistic regression.

Of the 752 patients with clinical stage I NSCLC, 92% (692 of 752) underwent surgical resection. In white men, white women, black men, and black women, the unadjusted surgical resection rates were 92%, 91%, 61%, and 90%, respectively. When multinomial logistic regression was performed, black men underwent full resections less often than white men (odds ratio, 0.15; 95% CI, 0.05-0.43).

Moreover, although white women and black women underwent surgery at rates that were comparable to white men, the odds of undergoing limited resection surgery instead of full resection surgery were 70% higher in white women than in white men (odds ratio, 1.69; 95% CI, 1.08-2.65).

The investigators concluded that as lung cancer screening disseminates into clinical practice, efforts designed to target black men should be prioritized. Clinicians need to effectively communicate the benefits of full surgical resection when screening patients with lung cancer. It should be noted that the equivalence of limited resection surgery to anatomic resection has not yet been clearly demonstrated.

Disclosures: Dr Wisnivesky has received consulting honorarium from Merck, AstraZeneca, and Quintiles as well as grants from Sanofi and Quorum. Dr Gould has received research support from PCORI and royalties from UpToDate.

References

1. Balekian AA, Wisnivesky JP, Gould MK. Surgical disparities among patients with stage I lung cancer in the National Lung Screening Trial [published online July 26, 2018]. CHEST. doi:10.1016/j.chest.2018.07.011
2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.