Skip to main content

Racial Disparities with Use of Chemotherapy plus Radiotherapy Among Patients with Stage III NSCLC

Conference Correspondent

Concurrent chemotherapy plus radiotherapy (CCRT) within 30 days is the standard of care for patients with locally advanced, stage III, non–small-cell lung cancer (NSCLC). Given that racial disparities exist in the management of lung cancer, the present study sought to analyze the proportion of black and white NSCLC patients who received standard CCRT and correlated their survival outcomes.

The study identified patients with stage III NSCLC diagnosed between 2004 and 2015 from the National Cancer Database. Based on the treatment received, 6 groups were identified: CCRT (0-30 days between chemotherapy [CT] and radiotherapy [RT]), sequential chemotherapy and radiotherapy (SCRT; 31-120 days between CT and RT), RT only, CT only, no RT or CT, and other (uncategorized).

The study included a total of 22,459 black patients and 138,477 white patients with stage III NSCLC. Overall, 42.3% of black patients versus 43.9% of white patients received CCRT, 7.6% versus 7.0% received SCRT, 13.8% versus 12.7% received RT only, 15.1% versus 14.9% received CT only, and 21.2% versus 21.5% did not receive RT or CT. Although black patients were diagnosed at an earlier age, the median time from diagnosis to treatment was longer for black patients compared with white patients for all 6 treatment groups.

Multivariate analysis identified male gender and white race as positive predictive factors for receiving CCRT, while patients aged ≥65 years, those with Medicare insurance and ≥1 comorbidities were less likely to be managed by CCRT. Both black and white populations derived survival benefit with CCRT treatment, with black patients deriving significantly more survival benefit with CCRT compared with white patients (median overall survival [OS], 18 months vs 16 months; P <.0001). Compared with those receiving CCRT, black patients had decreased OS outcomes with SCRT (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.09-1.22), RT only (HR, 1.97; 95% CI, 1.88-2.06), CT only (HR, 1.5; 95% CI, 1.44-1.57), and no RT or CT (HR, 2.63; 95% CI, 2.53-2.73). However, among white patients, SCRT (HR, 1.02; 95% CI, 1.0-1.05) was not associated with decreased OS compared with CCRT, whereas RT only (HR, 1.85; 95% CI, 1.82-1.88), CT only (HR, 1.39; 95% CI, 1.37-1.42), and no RT or CT (HR, 2.71; 95% CI, 2.67-2.75) were associated with decreased OS.

These results indicate that a lower proportion of black patients were managed with CCRT in clinical practice nationally, although black patients derived more survival benefit from CCRT compared with white patients.

Source: Elimimian EB, et al. J Clin Oncol. 2021;39(suppl 15):Abstract 8552.

Related Items