Disparities in treatment of patients with inoperable stage I non-small cell lung cancer: A population-based analysis

Matthew Koshy, Renuka Malik, Mike Spiotto, Usama Mahmood, Ralph Weichselbaum, David Sher

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND:: Patients unable to receive surgery for stage I non-small cell lung cancer (NSCLC) can undergo conventional radiotherapy (ConvRT), stereotactic body radiotherapy (SBRT), or no treatment (NoTx). This study assessed patterns of care and disparities in the receipt of each of these treatments. METHODS:: The study included patients in the National Cancer Database from 2003 to 2011 with T1-T2N0M0 inoperable lung cancer (n = 39,822). Logistic regressions were performed to determine predictors of receiving any radiation versus NoTx and for receiving SBRT versus ConvRT. RESULTS:: Treatment with radiation was significantly less likely in blacks (odds ratio, OR 0.65) and Hispanics (OR 0.42) compared with whites. Treatment with SBRT versus ConvRT was more likely in an academic research program (OR 2.62) and a high-volume facility (OR 7.00) compared with community cancer programs or low-volume facilities. In 2011, use of SBRT, ConvRT, and NoTx was 25%, 28%, and 46% for patients in a community cancer center versus 68%, 11%, and 21%, respectively, in an academic center (p < 0.0001). CONCLUSION:: There were marked institutional and socioeconomic variations in the treatment of inoperable stage I NSCLC. These results suggest that removal of barriers to receive radiation therapy and particularly improved access to SBRT may meaningfully improve survival in this disease.

Original languageEnglish (US)
Pages (from-to)264-271
Number of pages8
JournalJournal of Thoracic Oncology
Volume10
Issue number2
DOIs
StatePublished - Feb 6 2015

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Radiosurgery
Non-Small Cell Lung Carcinoma
Radiotherapy
Population
Radiation
Therapeutics
Neoplasms
Hispanic Americans
Lung Neoplasms
Logistic Models
Odds Ratio
Databases
Survival
Research

Keywords

  • Lung cancer
  • Radiation
  • Stage I
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Disparities in treatment of patients with inoperable stage I non-small cell lung cancer : A population-based analysis. / Koshy, Matthew; Malik, Renuka; Spiotto, Mike; Mahmood, Usama; Weichselbaum, Ralph; Sher, David.

In: Journal of Thoracic Oncology, Vol. 10, No. 2, 06.02.2015, p. 264-271.

Research output: Contribution to journalArticle

Koshy, Matthew ; Malik, Renuka ; Spiotto, Mike ; Mahmood, Usama ; Weichselbaum, Ralph ; Sher, David. / Disparities in treatment of patients with inoperable stage I non-small cell lung cancer : A population-based analysis. In: Journal of Thoracic Oncology. 2015 ; Vol. 10, No. 2. pp. 264-271.
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abstract = "BACKGROUND:: Patients unable to receive surgery for stage I non-small cell lung cancer (NSCLC) can undergo conventional radiotherapy (ConvRT), stereotactic body radiotherapy (SBRT), or no treatment (NoTx). This study assessed patterns of care and disparities in the receipt of each of these treatments. METHODS:: The study included patients in the National Cancer Database from 2003 to 2011 with T1-T2N0M0 inoperable lung cancer (n = 39,822). Logistic regressions were performed to determine predictors of receiving any radiation versus NoTx and for receiving SBRT versus ConvRT. RESULTS:: Treatment with radiation was significantly less likely in blacks (odds ratio, OR 0.65) and Hispanics (OR 0.42) compared with whites. Treatment with SBRT versus ConvRT was more likely in an academic research program (OR 2.62) and a high-volume facility (OR 7.00) compared with community cancer programs or low-volume facilities. In 2011, use of SBRT, ConvRT, and NoTx was 25{\%}, 28{\%}, and 46{\%} for patients in a community cancer center versus 68{\%}, 11{\%}, and 21{\%}, respectively, in an academic center (p < 0.0001). CONCLUSION:: There were marked institutional and socioeconomic variations in the treatment of inoperable stage I NSCLC. These results suggest that removal of barriers to receive radiation therapy and particularly improved access to SBRT may meaningfully improve survival in this disease.",
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