Race, Insurance, Type of Hospital Determine Lung Cancer Care Quality

Race, Insurance, Type of Hospital Determine Lung Cancer Care Quality

shutterstock_126693341A recent large-scale, multi-ethnic study found that disparities in the quality and extent of lung cancer care received were linked to a number of factors such as race, whether the facility was a community or academic hospital, and the patient’s insurance status. Lead author Dr. Matthew Koshy, a doctor at the department of radiation oncology at the University of Illinois at Chicago College of Medicine, said these barriers towards administering effective and early cancer care need to be addressed to improve lung cancer patients’ survival. The report is available in the Journal of Thoracic Oncology.

Patients with Stage I non-small cell lung cancer (NSCLC), if diagnosed early and immediately start treatment, have the best chances for long-term survival, as survival rates in later stages are extremely decreased. The most common intervention for Stage I NSCLC is to surgically remove the cancerous nodules from the lungs, but for the many patients that are not viable candidates for surgery, radiation therapy is prescribed.

Stereotactic body radiotherapy, or SBRT is today’s standard treatment for inoperable stage I NSCLC. This method delivers higher doses of radiation, which reduces the number of sessions needed. It is also better tolerated by patients, and offers survival rates at par with surgery.

Unfortunately, not all NSCLC patients receive the same level of healthcare. Dr. Koshy and his team of fellow researchers sought to find out what made patients more likely to either be merely monitored sans surgery and any form of radiation; treated with traditional radiation therapy, which yields significantly less favorable results; or treated with the new gold standard, SBRT. The team examined information from almost 40,000 patients with inoperable Stage I NSCLC, retrieved from the National Cancer Database, between the years 2003 and 2011.

They discovered African Americans and Hispanics were 40% and 60% less likely to be treated with either of the two radiotherapy options. Among patients who did receive radiotherapy, African Americans and patients without health insurance were least likely to be treated with SBRT. Additionally, patients who went to academic hospitals were 2.5 times more likely to be treated with SBRT compared to those seeking medical care in community hospitals, and those who went to high-volume facilities were 7 times more likely to receive SBRT. In 2011, nearly half of patients in community hospitals were merely observed, compared to the 21% in academic hospitals. Furthermore, 68% of those in academic hospitals were treated with SBRT, compared to only 25% in community hospitals.

Dr. Koshy and his team strongly suggest patients with inoperable Stage I NSCLC consult only with an experienced radiation oncologist, trained in administering SBRT. It is also crucial for steps to be taken on a nationwide level to equip more health centers with SBRT to reduce the amount of cancer care disparities in the country.

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