Racial disparities in the use of SBRT for treating early-stage lung cancer

Abstract

Objectives: Prior studies have shown that the surgical resection rate for black patients with early-stage lung cancer is significantly lower than that of white patients, which may partially explain the worse outcomes observed in this group. Over the past decade, however, there has been increasing utilization of stereotactic body radiotherapy (SBRT) as an alternative to surgical resection for inoperable patients. We undertook a population-based study to evaluate potential racial disparities in the use of SBRT.

Materials and methods: Using the National Cancer Database, black and white patients with Stage I NSCLC between 2003 and 2011 were identified. Patients were categorized based on primary treatment modality. Univariable and multivariable analyses were performed to identify demographic predictors of SBRT utilization in the non-operative population.

Results: A total of 113,312 patients met the inclusion criteria. When compared to white patients, black patients were less likely to receive surgical intervention (66% vs. 58%, P<0.001) or SBRT (6.1% vs. 5.5%, P<0.001), and more likely to receive standard fractionated external beam radiation (EBRT) or no treatment. When confined to the non-operative cohort, multivariable logistic regression confirmed black race to be negatively associated with SBRT use compared to less aggressive therapy.

Conclusion: In this national dataset, we confirmed prior observations that black patients are less likely to receive surgery than white patients, and also found that black patients are less likely to receive SBRT. This suggests that even with emerging utilization of SBRT for inoperable candidates, black patients continue to receive less aggressive therapy.

Keywords: Lung cancer; NSCLC; Racial disparities; SBRT; Stereotactic body radiotherapy.