Racial disparities in time from diagnosis to treatment for stage I non-small cell lung cancer

Abstract

Background: Delay in lung cancer treatment is associated with worse survival outcomes. We examined whether there are racial disparities in time from diagnosis to treatment initiation for stage I non-small cell lung cancer (NSCLC) using data from the National Cancer Data Base, which includes approximately 70% of incident cancer patients across the United States. Methods: We analyzed 119 184 patients diagnosed with stage I NSCLC from 2008 to 2013. Median times (in days) from diagnosis to treatment initiation for external beam radiation (EBRT), stereotactic body radiotherapy (SBRT), and surgery (inclusive of wedge resection, lobectomy, and pneumonectomy) were calculated separately and compared among white vs African American (AA) patients using the Wilcoxon rank-sum test. Multivariable linear regression assessed racial differences in days to treatment while adjusting for sex, age, insurance status, regional income, Charlson-Deyo comorbidity score, region, facility type, and treatment. Statistical tests were two-sided. Results: AA patients had a statistically significantly longer median time to treatment for all three treatment modalities: EBRT 54 days (AA) vs 48 days (white, P < .001); SBRT 66 days vs 55 days (P < .001); surgery 31 vs 26 days (P < .001). In addition, 34% AA vs 24% white patients (P ≤ .001) had treatment initiation eight or more weeks after diagnosis. In multivariable analysis, AA patients experienced an average 8.2-day delay compared with white patients (P < .001). Conclusions: These results shed light on one possible mechanism of the observed racial disparity in mortality outcomes in NSCLC. Future studies are needed to determine if interventions to reduce treatment delays can reduce racial disparities in this disease.