This study found that Black patients with extensive-stage small cell lung cancer were less likely to receive chemotherapy, as were elderly, uninsured, and those with non-private insurance.
A study published in JTO Clinical and Research Reports which utilized the National Cancer Data Base (NCDB) suggested that Black patients with extensive-stage small cell lung cancer (ES-SCLC) were less likely to receive chemotherapy, as were elderly, uninsured, and those with non-private insurance.1
Given these findings, researchers indicated it is necessary to address the underlying reasons for lack of chemotherapy receipt in these patient populations, and to help guide appropriate interventions to mitigate these disparities.
“Our study highlights the disparities that can exist in healthcare, and the impact that race and socioeconomic status can have on a patient’s experience throughout their treatment,” corresponding study author Umit Tapan, MD, a thoracic oncologist at Boston Medical Center and an assistant professor of medicine at Boston University School of Medicine, said in a press release.2
In total, 148,961 patients diagnosed with stage IV SCLC from 2004-2016 were identified within the NCDB. However, only 82,592 patients were included in the analysis, among which 6557 did not receive chemotherapy (7.9%).
Ultimately, the study revealed that higher education, recent year of diagnosis, and treatment at 1 or more facilities were associated with increased odds of receiving chemotherapy. Moreover, factors found to be associated with a decreased likelihood of receiving chemotherapy included increasing age, race, non-private insurance, and comorbidities.
On multivariate analysis, Black patients were shown to have lower odds of receiving chemotherapy when compared to white patients (aOR, 0.85; 95% CI, 0.77-0.93; P = .0004). However, Black patients also had slightly better survival compared to white patients (aHR, 0.91; 95% CI, 0.89-0.94; P = .91). The 1-year OS for Black and white patients was 31.7%, at a median of 8.3 months, and 28.6%, at a median of 8 months, respectively.
“While our study looked specifically at patients with extensive-stage small cell lung cancer, our results further demonstrate the impact that socioeconomic status can have on the health of patients, whether it be access to treatment or their outcomes,” Tapan added.
Importantly though, the treatment guidelines for this cancer type have changed since the time of the study period, with immunotherapy being approved for the front-line treatment of ES-SCLC. Additionally, the researchers were unable to account for some clinical variables that could have impacted treatment decisions and outcomes, such as information on performance status and detailed information regarding chemotherapy regimens, dosages, and subsequent treatments, which were not fully captured by the database used.
“Although some of our findings correlate with previously published reports, there were contrasting or new findings in our cohort that warrant further investigation,” the authors noted. “As chemotherapy is the most important predictor of survival in ES-SCLC, measures should be taken to address barriers related to racial and other sociodemographic factors that result in a decreased chance of receiving chemotherapy.”
1. Tapan U, Furtado VF, Qureshi MM, Everett P, Suzuki K, Mak KS. Racial and Other Healthcare Disparities in Patients with Extensive-Stage Small Cell Lung Cancer. JTO Clinical and Research Reports. doi: 10.1016/j.jtocrr.2020.100109
2. Prevalence of Racial, Insurance and Other Socioeconomic Disparities in Chemotherapy Treatment for Patients with Extensive-Stage Small Cell Lung Cancer [news release]. Boston. Published October 26, 2020. Accessed October 27, 2020. https://www.bmc.org/news/press-releases/2020/10/26/prevalence-racial-insurance-and-other-socioeconomic-disparities