Racial differences in treatment and survival among veterans and non-veterans with stage I NSCLC: An evaluation of veterans affairs and Seer-medicare populations

Background: Surgery is the preferred treatment for stage I non–small cell lung cancer (NSCLC), with radiation reserved for those not receiving surgery. Previous studies have shown lower rates of surgery among Blacks with stage I NSCLC than among Whites. Methods: Black and White men ages ≥65 years with stage I NSCLC diagnosed between 2001 and 2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Logistic regression and Cox proportional hazards models were used to examine associations between race, treatment, and survival. Results: Among the patients in the VA (n = 7,895) and SEER (n = 8,744), the proportion of Blacks was 13% and 7%, respectively. Overall, 16.2% of SEER patients (15.4% of Whites, 26.0% of Blacks) and 24.5% of VA patients received no treatment (23.4%

31.4% of Blacks). In both cohorts, Blacks were less likely to receive any treatment compared with Whites [OR_adj = 0.57; 95% confidence interval (CI), 0.47–0.69 for SEER-Medicare; OR_adj = 0.68; 95% CI, 0.58–0.79 for VA]. Among treated patients, Blacks were less likely than Whites to receive surgery only (OR_adj = 0.57; 95% CI, 0.47–0.70 for SEER-Medicare; OR_adj = 0.73; 95% CI, 0.62–0.86 for VA), but more likely to receive chemotherapy only and radiation only. There were no racial differences in survival. Conclusions: Among VA and SEER-Medicare patients, Blacks were less likely to get surgical treatment. Blacks and Whites had similar survival outcomes when accounting for treatment. Impact: This supports the hypothesis that equal treatment correlates with equal outcomes and emphasizes the need to understand multilevel predictors of lung cancer treatment disparities.