For Patients With Inoperable Stage I NSCLC, Race, Hospital, and Insurance Status Matter

Matthew Koshy, MD

Despite the proven benefits of stereotactic body radiotherapy (SBRT) for patients with inoperable stage I non—small cell lung cancer (NSCLC), whether such patients are offered it depends on their race, insurance status, and the type of facility where they are being treated, according to the findings of a recent population-based study reported in the Journal of Thoracic Oncology.

The study found that patients receiving care at an academic medical center were more than twice as likely to receive SBRT as those at community hospitals. The advantage was even greater when medical center volume was factored in, with patients receiving care at a high-volume medical center seven times more likely to access SBRT that those at a low-volume center.

Researchers found that race and ethnicity influence who accesses radiotherapy, too. African Americans were 40% less likely and Hispanics 60% less likely to be treated with either conventional radiation or SBRT. Of patients who did receive radiation, African Americans and those without insurance were less likely to receive SBRT.

“We found significant disparities for treatment of a curable cancer based on race, insurance status, and whether or not treatment was at an academic or community hospital,” Matthew Koshy, MD, a physician in the Department of Radiation Oncology at the University of Illinois at Chicago College of Medicine and lead study author, said in a statement. “Reducing these disparities could lead to significant improvements in survival for many people with inoperable early stage lung cancer.”

Although radiation therapy has been the standard treatment for patients who cannot undergo surgery to treat their stage I NSCLC, the benefits are regarded as minimal with this approach, and many patients deemed inoperable are only monitored. SBRT is now preferred for inoperable stage I NSCLC, because the approach delivers much higher doses of radiation, requires fewer treatments, is better tolerated, and offers survival outcomes comparable to surgery.

For their study, Koshy and colleagues sought to find out what, if any, factors forecast whether a patient was more likely to be observed, treated with conventional radiotherapy, or SBRT. They analyzed data from nearly 40,000 patients with inoperable stage I NSCLC who were added to the National Cancer Database between 2003 and 2011.

The researchers found that in 2011, 46% of patients receiving care in community care centers were only observed versus 21% of patients at academic medical centers, and 68% of patients at academic medical centers received SBRT compared with 25% of patients at community hospitals.

Koshy suggested that all patients with early-stage, inoperable lung cancer be evaluated by a radiation oncologist, adding that more radiation oncologists trained in SBRT are needed. Better access to facilities that offer SBRT could help reduce the disparities the study uncovered, he concluded.

Koshy M, Malik R, Spiotto M, et al. Disparities in treatment of patients with inoperable stage I non—small cell lung cancer: a population-based analysis [published online ahead of print November 3, 2014]. J Thorac Oncol.