CHICAGOA national study of nearly 11,000 patients confirmed
what previous regional studies have suggested: Black Americans are
less likely than whites to undergo surgery for early stage
non-small-cell lung cancer (NSCLC).
The variation in treatment may explain some of the differences in
survival that have been observed between blacks and whites, and it
indicates that physicians may be able to improve survival of black
patients by increasing their rates of surgical therapy, health
services researcher Peter Bach, MD, said at the Second Annual Cancer
Care Symposium sponsored by the Robert H. Lurie Comprehensive Cancer
Center of Northwestern University and others.
Dr. Bach and his colleagues at Memorial Sloan-Kettering Cancer Center
evaluated the care given to 10,984 Medicare patients identified as
having stage I or II NSCLC in the Surveillance Epidemiology and End
Results (SEER) database between 1985 and 1993. Analysis of data from
this review concluded that race was associated with treatment for
early stage NSCLC.
There was a 12.7% absolute difference in the rate of surgery between
whites and blacks; a total of 76.7% of white patients had surgery,
compared with 64% of black patients. The likelihood that a black
patient would have surgery vs a white patient was 0.83, and the odds
ratio for a black patient to have surgery, compared with a white
patient, was 0.51.
This disparity translated into higher overall mortality for blacks.
Overall 5-year survival for the patients in the study was 34% for
white patients and 26% for black patients.
There was no statistically significant difference in survival when
patients had the same treatment. For patients having surgery, the
5-year survival rate was 43% for white patients and 39% for black
patients. White patients who did not undergo surgery had a 5%
survival rate at 5 years, compared with 4% for black patients who had
Although there is a large overall difference in survival, there
is no apparent survival difference based on treatment. This is good
evidence that race does not affect treatment outcome, he said.