Racial Disparities Among Lung Cancer Patients Referred for Surgery
In a study published in the January issue of Archives of Surgery, Dr Farjah and colleagues looked at the possible reasons why blacks with operable lung cancer were more likely than whites with the same condition to reject surgery. In looking at the 10 years of data, the researchers found no significant difference in outcomes between the groups.
In their study, insurance was not a factor in choice of treatment. All patients included in the study -- black and white -- were covered by Medicare.
The study looked at 17,739 patients with stage I or II lung cancer in the Surveillance, Epidemiology, and End Results (SEER) Medicare database who were treated between Jan. 1, 1992 though Dec. 31, 2002. All were referred for surgery.
The study found that only 69% of the black patients had surgery compared to 83% of the white patients.
When the patient and disease characteristics were adjusted for there was only a small and statistically insignificant difference between the two groups, even though 14% fewer blacks than white patients underwent surgery.
This lack of a difference in outcome suggests that there is still much to be learned about treating lung cancer.
Therefore, why are black patients less likely to undergo the recommended surgery for treatment of their lung cancer?
The authors offered the following possible explanations:
1. Black patients are more likely to believe that surgery increases the spread of the tumor.
2. Black patients are more likely to believe in the possibility of cure without resection.
3. Black patients are more likely to distrust of the health care system and providers.
4. Limited access to care. There is some evidence to support the fact that primary care physicians treating black patients had less access to high-quality subspecialists compared with physicians treating white patients.
5. The authors leave open the possibility that "racial differences in care is that health care system and provider biases may exist even in a setting where optimal therapy is recommended."
6. Other factors not measured in their study or previously investigated—such as racial variation in distance, travel, family support, or social support -- might also explain racial differences in the receipt of lung resection.
The authors write "the major limitation of this study is concern over the accuracy and validity of the recommended surgery variable within the SEER database. Although SEER data are considered highly valid, to our knowledge there are no published third-party evaluations of the validity and accuracy of this variable. "
Racial Disparities Among Patients with Lung Cancer Who Were Recommended Operative Therapy; Arch Surg 2009; 144: 14-18; Farjah F, et al