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Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations.

Publication ,  Journal Article
Williams, CD; Alpert, N; Redding, TS; Bullard, AJ; Flores, RM; Kelley, MJ; Taioli, E
Published in: Cancer Epidemiol Biomarkers Prev
January 2020

BACKGROUND: Surgery is the preferred treatment for stage I non-small cell lung cancer (NSCLC), with radiation reserved for those not receiving surgery. Previous studies have shown lower rates of surgery among Blacks with stage I NSCLC than among Whites. METHODS: Black and White men ages ≥65 years with stage I NSCLC diagnosed between 2001 and 2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Logistic regression and Cox proportional hazards models were used to examine associations between race, treatment, and survival. RESULTS: Among the patients in the VA (n = 7,895) and SEER (n = 8,744), the proportion of Blacks was 13% and 7%, respectively. Overall, 16.2% of SEER patients (15.4% of Whites, 26.0% of Blacks) and 24.5% of VA patients received no treatment (23.4% of Whites, 31.4% of Blacks). In both cohorts, Blacks were less likely to receive any treatment compared with Whites [ORadj = 0.57; 95% confidence interval (CI), 0.47-0.69 for SEER-Medicare; ORadj = 0.68; 95% CI, 0.58-0.79 for VA]. Among treated patients, Blacks were less likely than Whites to receive surgery only (ORadj = 0.57; 95% CI, 0.47-0.70 for SEER-Medicare; ORadj = 0.73; 95% CI, 0.62-0.86 for VA), but more likely to receive chemotherapy only and radiation only. There were no racial differences in survival. CONCLUSIONS: Among VA and SEER-Medicare patients, Blacks were less likely to get surgical treatment. Blacks and Whites had similar survival outcomes when accounting for treatment. IMPACT: This supports the hypothesis that equal treatment correlates with equal outcomes and emphasizes the need to understand multilevel predictors of lung cancer treatment disparities.

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Published In

Cancer Epidemiol Biomarkers Prev

DOI

EISSN

1538-7755

Publication Date

January 2020

Volume

29

Issue

1

Start / End Page

112 / 118

Location

United States

Related Subject Headings

  • White People
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • SEER Program
  • Radiotherapy
  • Pneumonectomy
  • Neoplasm Staging
  • Medicare
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Williams, C. D., Alpert, N., Redding, T. S., Bullard, A. J., Flores, R. M., Kelley, M. J., & Taioli, E. (2020). Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations. Cancer Epidemiol Biomarkers Prev, 29(1), 112–118. https://doi.org/10.1158/1055-9965.EPI-19-0245
Williams, Christina D., Naomi Alpert, Thomas S. Redding, A Jasmine Bullard, Raja M. Flores, Michael J. Kelley, and Emanuela Taioli. “Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations.Cancer Epidemiol Biomarkers Prev 29, no. 1 (January 2020): 112–18. https://doi.org/10.1158/1055-9965.EPI-19-0245.
Williams CD, Alpert N, Redding TS, Bullard AJ, Flores RM, Kelley MJ, et al. Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations. Cancer Epidemiol Biomarkers Prev. 2020 Jan;29(1):112–8.
Williams, Christina D., et al. “Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations.Cancer Epidemiol Biomarkers Prev, vol. 29, no. 1, Jan. 2020, pp. 112–18. Pubmed, doi:10.1158/1055-9965.EPI-19-0245.
Williams CD, Alpert N, Redding TS, Bullard AJ, Flores RM, Kelley MJ, Taioli E. Racial Differences in Treatment and Survival among Veterans and Non-Veterans with Stage I NSCLC: An Evaluation of Veterans Affairs and SEER-Medicare Populations. Cancer Epidemiol Biomarkers Prev. 2020 Jan;29(1):112–118.

Published In

Cancer Epidemiol Biomarkers Prev

DOI

EISSN

1538-7755

Publication Date

January 2020

Volume

29

Issue

1

Start / End Page

112 / 118

Location

United States

Related Subject Headings

  • White People
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • SEER Program
  • Radiotherapy
  • Pneumonectomy
  • Neoplasm Staging
  • Medicare
  • Male