Elderly blacks and whites are not getting the same care for lung cancer

HOUSTON – (April 13, 2009) – When it comes to the treatment of lung cancer in the elderly, blacks are less likely to get chemotherapy or surgery than whites, according to a new study by epidemiologists at The University of Texas School of Public Health that appears in the May 15 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The investigators found that lung cancer treatment disparities between blacks and whites were just as large in 2002, as they were in the early 1990s, despite efforts to address inequalities in medical treatment. In fact, the gap between blacks and whites is more pronounced among women, older patients or people in the poorest socioeconomic quartile.

To remedy the situation, the authors wrote, “Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment.”

UT School of Public Health researchers Dale Hardy, Ph.D., and Xianglin Du., M.D., Ph.D.

The researchers conducted a retrospective study of 83,101 seniors who were enrolled in Medicare between 1991 and 2002 and diagnosed with non-small cell lung cancer. Medicare is the official federal health insurance for people 65 years of age or more and those with disabilities. Lung cancer is the leading cause of death from all types of cancers in the United States with an estimated 161,840 deaths in 2008.

Non-small cell lung cancer accounts for nearly 90 percent of lung cancer.

“We thought the disparity would have narrowed,” said Dale Hardy, Ph.D., lead author and research associate at the UT School of Public Health. “We were surprised that the gap is still there.”

Hardy now plans to analyze the impact of this treatment disparity on patient outcomes.

In their analysis, the investigators found that blacks with early stage lung cancer were 37 percent less likely than whites to receive surgery and 42 percent less likely to receive chemotherapy. Researchers found no significant difference between blacks and whites when it came to people receiving radiation for advanced stage cancer.

During the advanced stages of cancer, blacks were 57 percent less likely to receive chemotherapy than whites.

Factors contributing to the treatment disparities, according to the researchers, could include blacks being less likely than whites to receive recommendations for surgery and more likely to refuse recommendations for surgical treatments.

Xianglin Du., M.D., Ph.D., an associate professor of epidemiology at the UT School of Public Health, was senior author. Other UT School of Public Health contributors include: Chih-Chin Liu, graduate student; Rui Xia, graduate student; Wenyaw Chan, Ph.D., professor of biostatistics; Arica White, predoctoral fellow; and Keith Burau, Ph.D., associate professor of biostatistics. Janice N. Cormier, M.D., associate professor of surgical oncology and biostatistics at The University of Texas M. D. Anderson Cancer Center, also collaborated on the study.

The study is titled “Racial Disparities and Treatment Trends in a Large Cohort of Elderly Black and White Patients with Nonsmall Cell Lung Cancer.” The study was supported by a grant from the Agency for Healthcare Research and Quality.

Media Contact: Robert Cahill Robert.Cahill@uth.tmc.edu Media Hotline: 713-500-3030