Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations
| Autor: | A. Jasmine Bullard, Emanuela Taioli, Thomas S. Redding, Naomi Alpert, Raja M. Flores, Christina D. Williams, Michael J. Kelley |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Lung Neoplasms Epidemiology Antineoplastic Agents Logistic regression Medicare White People 03 medical and health sciences 0302 clinical medicine Internal medicine Carcinoma Non-Small-Cell Lung medicine Carcinoma Humans Healthcare Disparities Lung cancer Pneumonectomy Veterans Affairs Aged Neoplasm Staging Veterans Aged 80 and over Radiotherapy business.industry Proportional hazards model medicine.disease Confidence interval United States Cancer registry Black or African American United States Department of Veterans Affairs 030104 developmental biology Oncology 030220 oncology & carcinogenesis business SEER Program |
| Zdroj: | Cancer epidemiology, biomarkersprevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 29(1) |
| ISSN: | 1538-7755 |
| Popis: | Background: Surgery is the preferred treatment for stage I non–small cell lung cancer (NSCLC), with radiation reserved for those not receiving surgery. Previous studies have shown lower rates of surgery among Blacks with stage I NSCLC than among Whites. Methods: Black and White men ages ≥65 years with stage I NSCLC diagnosed between 2001 and 2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Logistic regression and Cox proportional hazards models were used to examine associations between race, treatment, and survival. Results: Among the patients in the VA (n = 7,895) and SEER (n = 8,744), the proportion of Blacks was 13% and 7%, respectively. Overall, 16.2% of SEER patients (15.4% of Whites, 26.0% of Blacks) and 24.5% of VA patients received no treatment (23.4% of Whites, 31.4% of Blacks). In both cohorts, Blacks were less likely to receive any treatment compared with Whites [ORadj = 0.57; 95% confidence interval (CI), 0.47–0.69 for SEER-Medicare; ORadj = 0.68; 95% CI, 0.58–0.79 for VA]. Among treated patients, Blacks were less likely than Whites to receive surgery only (ORadj = 0.57; 95% CI, 0.47–0.70 for SEER-Medicare; ORadj = 0.73; 95% CI, 0.62–0.86 for VA), but more likely to receive chemotherapy only and radiation only. There were no racial differences in survival. Conclusions: Among VA and SEER-Medicare patients, Blacks were less likely to get surgical treatment. Blacks and Whites had similar survival outcomes when accounting for treatment. Impact: This supports the hypothesis that equal treatment correlates with equal outcomes and emphasizes the need to understand multilevel predictors of lung cancer treatment disparities. |
| Databáze: | OpenAIRE |
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