Disparities in Receiving Guideline-Concordant Treatment for Lung Cancer in the United States.

Abstract

RATIONALE\nThe level of adherence to lung cancer treatment guidelines in the United States is unclear. Also, it is unclear whether previously identified disparities by racial/ethnic group and by age persist across all clinical subgroups.\n\n\nOBJECTIVES\nTo assess the level of adherence to the minimal lung cancer treatment recommended by the National Comprehensive Cancer Network guidelines (guideline-concordant treatment) in the United States, and to assess the persistence of disparities by racial/ethnic group and by age across all clinical subgroups.\n\n\nMETHODS\nWe evaluated whether 441,812 lung cancer cases in the National Cancer Database diagnosed between 2010-2014 received guideline-concordant treatment. Multivariable logistic regression models were used to assess possible disparities in receiving guideline-concordant treatment by racial/ethnic group and by age across all clinical subgroups, and whether these persist after adjusting for patient, tumor, and health care provider characteristics.\n\n\nRESULTS\nOverall, 62.1% of subjects received guideline-concordant treatment (range across clinical subgroups: 50.4%-76.3%). However, 21.6% received no treatment (range: 10.3%-31.4%) and 16.3% received less intensive treatment than recommended (range: 6.4%-21.6%). Among the most common less intensive treatments for all subgroups was conventionally fractionated radiotherapy only (range: 2.5%-16.0%), as was chemotherapy only for non-metastatic subgroups (range: 1.2% to 13.7%), and conventionally fractionated radiotherapy & chemotherapy for localized non-small cell lung cancer (5.9%). Guideline-concordant treatment was less likely with increasing age despite adjusting for relevant covariates (age ≥80 compared to <50: adjusted odds ratio [aOR]=0.12, 95% confidence interval [95%CI]=0.12-0.13). This disparity was present in all clinical subgroups. Also, non-Hispanic Blacks were less likely to receive guideline-concordant treatment than non-Hispanic Whites (aOR=0.78, 95%CI=0.76-0.80). This disparity was present in all clinical subgroups, although statistically non-significant for extensive disease small cell lung cancer.\n\n\nCONCLUSIONS\nBetween 2010-2014, many lung cancer patients in the United States received no treatment or less intensive treatment than recommended. Particularly, elderly lung cancer patients and non-Hispanic Blacks are less likely to receive guideline-concordant treatment. Patterns of care among those receiving less intensive treatment than recommended suggest room for improved uptake of treatments such as Stereotactic Body Radiation Therapy among localized non-small cell lung cancer.