Thoracic: Lung Cancer
Disparities in early-stage lung cancer outcomes at minority-serving hospitals compared with nonminority serving hospitals

Read at the 102nd Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 14-17, 2022.
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Abstract

Objectives

Disparities in cancer care are omnipresent and originate from a multilevel set of barriers. Our objectives were to describe the likelihood of undergoing surgery for early-stage non–small cell lung cancer at minority-serving hospitals (MSHs), and evaluate the association of race/ethnicity with resection based on MSH status.

Methods

A retrospective study using the National Cancer Database (2008-2016) was conducted including patients with clinical stage I non–small cell lung cancer. MSHs were defined as hospitals in the top decile of providing care to Hispanic or African American patients. The primary outcome evaluated was receipt of definitive surgery at MSHs vs non-MSHs. Outcomes related to race/ethnicity stratified by hospital type were also investigated.

Results

A total of 142,580 patients were identified from 1192 hospitals (120 MSHs and 1072 non-MSHs). Most patients (85% [n = 121,240]) were non-Hispanic White, followed by African American (9% [n = 12,772]), and Hispanic (3%, [n= 3749]). MSHs cared for 7.4% (n = 10,491) of the patients included. In adjusted analyses, patients treated at MSHs were resected less often than those at non-MSHs (odds ratio, 0.87; 95% CI, 0.76-1.00; P = .0495). African American patients were less likely to receive surgery in the overall analysis (P < .01), and at MSHs specifically (P < .01), compared with non-Hispanic White patients. Hispanic patients had similar rates of resection in the overall analysis (P = .11); however, at MSHs, they underwent surgery more often compared with non-Hispanic White patients (P = .02). Resected patients at MSHs had similar overall survival (median, 91.7 months; 95% CI, 86.6-96.8 months) compared with those resected at non-MSHs (median, 85.7 months; 95% CI, 84.5-86.8 months).

Conclusions

Patients with early-stage non–small cell lung cancer underwent resection less often at MSHs compared with non-MSHs. Disparities related to underutilization of surgery for African American patients continue to persist, regardless of hospital type.

Section snippets

Study Design and Population

This was a retrospective cohort study using data from the National Cancer Data Base (NCDB) (http://ncdbpuf.facs.org/). Patients diagnosed with clinical stage I non–small cell lung cancer (NSCLC) between 2008 and 2016 were included. Demographic data obtained included age, sex, race/ethnicity, geographic location, insurance type, and median income. Median income was derived from American Community Survey data and patient zip code. Clinicopathologic data evaluated included variables such as tumor

Demographic and Clinicopathologic Data

A total of 142,580 patients with clinical stage I NSCLC were identified from 1192 hospitals. There were 120 hospitals categorized as MSHs, whereas 1072 were classified as non-MSHs. The most common age group was 71 to 80 years (n = 47,740 [33%]). The majority of patients were non-Hispanic White (NHW) (n = 121,240 [85%]) followed by African American (n = 12,772 [9%]), Hispanic (n = 3749 [3%]), and Asian (n = 3023 [2%]). Most patients obtained care at non-MSHs (n = 132,089 [92.6%]), whereas 7.4%

Discussion

Surgical resection continues to be the mainstay of therapy for patients with operable early-stage NSCLC. In this study, we found that MSHs performed surgery in this population significantly less often than non-MSHs. However, when surgery was performed, the quality of surgical and oncologic care, as well as OS, was similar between MSHs and non-MSHs. Additionally, regardless of hospital type, African American patients were less likely to undergo definitive resection compared with their NHW

Conclusions

Patients with stage I NSCLC treated at MSHs underwent resection significantly less often compared with those cared for at non-MSHs. When surgical care was obtained at MSHs, it appears to be of similar oncologic and surgical quality compared with non-MSHs, despite diminished resources and funding.4,32 Qualitative work may further inform the reasons underlying disparities in surgical utilization between these hospital types.

References (32)

  • C.K. Zogg et al.

    Medicareʼs hospital Acquired Condition Reduction Program disproportionately affects minority-serving hospitals: variation by race, socioeconomic status, and disproportionate share hospital payment receipt

    Ann Surg

    (2020)
  • P.W. Lu et al.

    Racial disparities in treatment for rectal cancer at minority-serving hospitals

    J Gastrointest Surg

    (2020)
  • N. Deboever et al.

    Current surgical indications for non–small-cell lung cancer

    Cancers (Basel)

    (2022)
  • Clinical Practice Guidelines in Oncology Non-Small Cell Lung Cancer

    (2021)
  • C. Grenade et al.

    Race and ethnicity in cancer therapy: what have we learned?

    Clin Pharmacol Ther

    (2014)
  • C.S. Lathan et al.

    The effect of race on invasive staging and surgery in non–small-cell lung cancer

    J Clin Oncol

    (2006)
  • Cited by (0)

    Supported by contributions from the Mason Family Research Fund.

    Internal Review Board Approval No.: 2021 to 0752 (approved August 24, 2021).

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