Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI.
Department of Biostatistics, University of Michigan, Ann Arbor, MI.
JCO Oncol Pract. 2022 Jun;18(6):e1034-e1044. doi: 10.1200/OP.21.00224. Epub 2022 Feb 15.
Historical racial disparities in lung cancer surgery rates resulted in lower survival in Black patients. Our objective was to examine racial differences in thoracic radiation treatments and toxicities in patients with non-small-cell lung cancer.
A large institutional review board-approved statewide patient-level database of patients with stage II-III non-small-cell lung cancer who received definitive thoracic radiation from March 2012 to November 2019 was analyzed to assess associations between race and other variables. Race (White or Black) was defined by patient self-report. Provider-reported toxicity was defined by Common Terminology Criteria for Adverse Events version 4.0. Patient-reported toxicity was determined by the Functional Assessment of Cancer Therapy-Lung quality-of-life instrument. Univariable and multivariable regression models were fitted to assess relationships between race and variables of interest. Spearman rank-correlation coefficients were calculated between provider-reported toxicity and similar patient-reported outcomes.
One thousand four hundred forty-one patients from 24 institutions with mean age 68 years (range, 38-94 years) were evaluated. Race was not significantly associated with radiation or chemotherapy approach. There was significantly increased patient-reported general pain in Black patients at the preradiation and end-of-radiation time points. Black patients were significantly less likely to have provider-reported grade 2+ pneumonitis (odds ratio 0.36, = .03), even after controlling for known patient and treatment factors. Correlation coefficients between provider- and patient-reported toxicities were generally similar across race groups except for a stronger correlation between patient- and provider-reported esophagitis in White patients.
In this large multi-institutional study, we found no evidence of racial differences in radiation treatment or chemotherapy approaches. We did, however, unexpectedly find that Black race was associated with lower odds of provider-reported grade 2+ radiation pneumonitis. The stronger correlation between patient- and provider-reported esophagitis and swallowing symptoms for White patients also suggests possible under-recognition of symptoms in Black patients. Further research is needed to study the implications for Black patients.
历史上肺癌手术率的种族差异导致黑人患者的生存率降低。我们的目的是研究非小细胞肺癌患者接受胸部放疗的种族差异和毒性。
对 2012 年 3 月至 2019 年 11 月接受确定性胸部放疗的 II-III 期非小细胞肺癌患者进行了一项大型机构审查委员会批准的全州患者水平数据库分析，以评估种族与其他变量之间的关联。种族（白人或黑人）由患者自我报告定义。根据不良事件通用术语标准 4.0 版定义提供者报告的毒性。患者报告的毒性由癌症治疗-肺功能评估工具的生活质量量表确定。采用单变量和多变量回归模型评估种族与感兴趣变量之间的关系。计算提供者报告的毒性与类似患者报告的结果之间的斯皮尔曼等级相关系数。
从 24 家机构评估了 1441 名平均年龄为 68 岁（范围 38-94 岁）的患者。种族与放疗或化疗方法无显著相关性。黑人患者在放疗前和放疗结束时的患者报告的一般疼痛明显增加。即使在控制了已知的患者和治疗因素后，黑人患者发生 2+级放射性肺炎的可能性也明显降低（优势比 0.36， =.03）。除了白人患者中患者报告的食管炎与提供者报告的食管炎之间的相关性更强外，种族组之间提供者和患者报告的毒性之间的相关系数通常相似。
在这项大型多机构研究中，我们没有发现种族差异对放疗或化疗方法的证据。然而，我们确实意外地发现，黑人种族与提供者报告的 2+级放射性肺炎的可能性降低有关。白人患者中患者报告的食管炎和吞咽症状与提供者报告的食管炎之间的相关性更强，这也表明黑人患者的症状可能未被充分识别。需要进一步研究以研究对黑人患者的影响。
