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Lung cancer remains the deadliest solid cancer in the world, although survival rates have improved over the past decade. However, African American patients have worse outcomes and shorter lifespans after being diagnosed with lung cancer. A new study examines recent data and shows that while black patients are more likely to receive the most effective treatment than they were a decade ago, inequality persists.

“We wanted to take a closer look at the surgery – the most effective therapy – and how the other two second-line treatment options can affect the differences in long-term outcomes between populations,” says Dr. med. Olugbenga Okusanya, Assistant Professor of Surgery at Thomas Jefferson University and researcher at Sidney Kimmel Cancer Center-Jefferson Health. “There was concern that these second-line treatments contributed to the mixed results.”

The results were published in the Journal of Surgical Oncology.

The most effective treatment for early-stage non-small cell lung cancer is surgery to remove part of the lung. However, two types of radiation therapy are also used as second-line therapy, with stereotactic ablative radiation therapy (SABR) proving to be more effective than external radiation therapy (EBRT) for diseases in the early stages.

The researchers examined data from 192,415 patients in the National Cancer Database who were diagnosed with early-stage (stage 1) non-small cell lung cancer between 2004 and 2015. Of these patients, 91% were white and 9% were black. “Few reports have included so many patients, dealing with both surgery and radiation therapy,” says Dr. Okusanya.

The greatest inequality was in the use of surgery, the most effective form of therapy for early-stage lung cancer, a difference that persisted through each year of the 11-year study period. Although the use of surgery increased over time in both white and black patients, the rate of increase was faster in black than in white patients. “This suggests that some work is being done to address the inequality in the use of surgery in black patients,” says Dr. Okusanya.

Dr. Okusanya and colleagues showed that SABR use increased from 2004 to 2015 and the EBRT rate decreased as expected, based on reports that EBRT was less effective for these patients. There were no differences between the racial groups in these two second-line therapies.

“The incidence and mortality of lung cancer in the Greater Philadelphia area is profound and far exceeds national averages. Studies such as these are critical to understanding factors that contribute to cancer differences and part of the overall mission of the Sidney Kimmel Cancer Center, the Improving lives of all cancer patients and their families, “said Dr. Karen E. Knudsen, executive vice president of oncology services at Jefferson Health and director of the Sidney Kimmel Cancer Center – Jefferson Health. “Differences in care among different population groups are simply unacceptable. Raising awareness of this problem through Dr. Okusanya’s work is the first step in a meaningful change.”

In addition, other studies have shown that comorbidities in black patients were one of the drivers of poorer outcomes and not the use of surgery. “In contrast, we found that black patients actually have a better survival rate than their white counterparts during surgery,” says Dr. Okusanya.

“We must continue to remove the barriers to successful treatment of black cancer patients,” says Dr. Okusanya. “We know these differences exist between cancers and treatments, and understanding some of the drivers of these inequalities is key to addressing these differences.”

Racial differences in surgery rates for esophageal cancer

More information:
Waseem Lutfi et al., Racial Differences in Local Therapy for Early Non-Small Cell Lung Cancer, Journal of Surgical Oncology (2020). DOI: 10.1002 / jso.26206 Provided by Thomas Jefferson University

Quote: Despite the increases (2020, October 28), which were accessed on October 28, 2020 at, racial Differences in the treatment of common lung cancer

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