Holmes Jordan A, Chen Ronald C
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
JNCI Cancer Spectr. 2018 Apr 25;2(1):pky007. doi: 10.1093/jncics/pky007. eCollection 2018 Jan.
Delay in lung cancer treatment is associated with worse survival outcomes. We examined whether there are racial disparities in time from diagnosis to treatment initiation for stage I non-small cell lung cancer (NSCLC) using data from the National Cancer Data Base, which includes approximately 70% of incident cancer patients across the United States.
We analyzed 119 184 patients diagnosed with stage I NSCLC from 2008 to 2013. Median times (in days) from diagnosis to treatment initiation for external beam radiation (EBRT), stereotactic body radiotherapy (SBRT), and surgery (inclusive of wedge resection, lobectomy, and pneumonectomy) were calculated separately and compared among white vs African American (AA) patients using the Wilcoxon rank-sum test. Multivariable linear regression assessed racial differences in days to treatment while adjusting for sex, age, insurance status, regional income, Charlson-Deyo comorbidity score, region, facility type, and treatment. Statistical tests were two-sided.
AA patients had a statistically significantly longer median time to treatment for all three treatment modalities: EBRT 54 days (AA) vs 48 days (white, < .001); SBRT 66 days vs 55 days ( < .001); surgery 31 vs 26 days ( < .001). In addition, 34% AA vs 24% white patients ( ≤ .001) had treatment initiation eight or more weeks after diagnosis. In multivariable analysis, AA patients experienced an average 8.2-day delay compared with white patients ( < .001).
These results shed light on one possible mechanism of the observed racial disparity in mortality outcomes in NSCLC. Future studies are needed to determine if interventions to reduce treatment delays can reduce racial disparities in this disease.
肺癌治疗延迟与较差的生存结果相关。我们利用国家癌症数据库的数据，研究了Ⅰ期非小细胞肺癌（NSCLC）从诊断到开始治疗的时间是否存在种族差异，该数据库涵盖了美国约70%的新发癌症患者。
我们分析了2008年至2013年期间诊断为Ⅰ期NSCLC的119184例患者。分别计算了接受外照射放疗（EBRT）、立体定向体部放疗（SBRT）和手术（包括楔形切除术、肺叶切除术和全肺切除术）从诊断到开始治疗的中位时间（以天为单位），并使用Wilcoxon秩和检验比较了白种人与非裔美国人（AA）患者之间的差异。多变量线性回归评估了在调整性别、年龄、保险状况、地区收入、Charlson-Deyo合并症评分、地区、机构类型和治疗等因素后，种族在治疗天数上的差异。统计检验为双侧检验。
AA患者在所有三种治疗方式下的中位治疗时间在统计学上均显著更长：EBRT为54天（AA）对48天（白种人，P<0.001）；SBRT为66天对55天（P<0.001）；手术为31天对26天（P<0.001）。此外，34%的AA患者与24%的白种患者（P≤0.001）在诊断后8周或更长时间才开始治疗。在多变量分析中，与白种患者相比，AA患者平均延迟8.2天（P<0.001）。
这些结果揭示了NSCLC死亡率结果中观察到的种族差异的一种可能机制。未来需要开展研究，以确定减少治疗延迟的干预措施是否能够减少该疾病中的种族差异。
