The ongoing outcomes research collaboration between HealthHelp and Humana has recently examined racial disparities in the non-medical treatment of lung cancer. As a result of the effort, the team presented a conference abstract examining racial disparities in non-medical Stage 1 lung cancer treatment at the National Comprehensive Cancer Network (NCCN) Annual Meeting, held virtually from March 31st through April 2nd, 2022. A related abstract focusing on Stage 3 lung cancer treatment was published online by the American Society of Clinical Oncology (ASCO) on May 26th, 2022, ahead of its annual meeting. Both abstracts were written as a part of a larger effort to examine whether patient race is associated with the type and timeliness of the lung cancer treatment that patients receive.
In the 1990s, it was demonstrated that Black patients were less likely to receive timely treatment for lung cancer than White patients. While contemporary work has found racial disparities in accessing insurance, diagnostics, and treatments, the team wished to explore whether patients faced disparities once in treatment. To do this, the team examined whether racial disparities were observable in a 2019 cohort of Medicare Advantage beneficiaries receiving treatment for lung cancer.
The analyses of patients with Stage 1 and Stage 3 lung cancer were conducted using similar retrospective, observational datasets. The analyses used health plan claims data to identify Black and White patients aged 18 to 89 years with a Medicare Advantage health plan in calendar year 2019 who received diagnostic imaging (computed tomography or positron emission tomography) followed by lung cancer treatment (radiation therapy [RT] or surgery claims mentioning a diagnosis of lung cancer) within 90 days. Only patients treated in 2019 were considered so that the findings would reflect the state of care immediately preceding the COVID-19 pandemic. Patients were excluded if they had a history of RT or lung surgery in the year prior to the diagnostic imaging date. Other databases were used to determine cancer stage, patient demographics, comorbidities, the urbanicity and median income of patients’ home ZIP code, and whether treatment was ordered by a hospital-based physician. A multivariate logistic model was used to examine the association between race and surgery, and a multivariate negative binomial model was used to examine the association between race and days to treatment (surgery or RT).
In both adjusted analyses, no association was found between the race of the patient receiving treatment and whether the patient received surgery, or between the race of the patient receiving treatment and the number of days the patient waited to receive treatment. Although no disparities were identified, there are several limitations that must be considered when interpreting the results. The patients included in the analysis were not a nationally-representative sample, as the national organization providing their health plans is predominantly present in the South. Furthermore, the patients differed from the American population overall, in that they were all uniformly insured with Medicare Advantage health plans from one organization. By design, all patients included in the study had received treatment for lung cancer, in the form of RT, surgery, or both. Thus, patients that were unable to be both diagnosed and treated were excluded from the analysis. As a result, the findings examine health equity in the context of a population that has been successfully able to access care.
In response to the findings, the lead author of the abstracts, Adam C. Powell, Ph.D., remarked, “It is heartening to see that, among a population of insured patients that has been successfully able to access lung cancer treatment, there was not an association between patient race and the timeliness or type of treatment received. That said, racial disparities in access to insurance, access to diagnosis, and access to treatment are well-documented, and thus there is much work that still needs to be done in addressing racial disparities throughout the healthcare system.”
To learn more about NCCN’s annual conference, visit: https://www.nccn.org/education-research/educational-events-and-programs/annual-conference
To learn more about ASCO’s annual meeting, visit: https://conferences.asco.org/am/attend
To read the ASCO abstract, visit: https://meetings.asco.org/abstracts-presentations/206578