Journal Article

Race and Sex Differences in the Receipt of Timely and Appropriate Lung Cancer Treatment

Ashwood, J. Scott, Shugarman, Lisa R., Mack, Katherine, Sorbero, Melony E. S., Tian, Haijun, Jain, Arvind K., Asch, Steven M.

2009

Overview

Background: Previous research suggests that disparities in nonsmall-cell lung cancer (NSCLC) survival can be explained in part by disparities in the receipt of cancer treatment. Few studies, however, have considered race and sex disparities in the timing and appropriateness of treatment across stages of diagnosis. Objective: To evaluate the relationship of sex and race with the receipt of timely and clinically appropriate NSCLC treatment for each stage of diagnosis. Method: Surveillance Epidemiology and End Result data linked to Medicare claims for beneficiaries diagnosed with NSCLC between 1995 and 1999 were used to evaluate the relationship between race and sex with timely and appropriate NSCLC treatment while controlling for other demographic characteristics, comorbidities, socioeconomic status, and provider supply (N = 22,145). Results: Overall adjusted rates of timely and appropriate treatment are 37.2%, 58.1%, and 29.2% for Medicare beneficiaries diagnosed with stage I or II, III, and IV NSCLC, respectively. Among stage I or II patients, women were 25% less likely to receive timely surgical resection relative to men, and blacks were 66% less likely to receive timely and appropriate treatment than whites. Black men were least likely to receive resection (22.2% compared with 43.7% for white men). Blacks were 34% less likely to receive timely surgery, chemotherapy, or radiation for stage III disease and were 51% less likely to receive chemotherapy in a timely fashion for stage IV disease relative to whites. Conclusion: Significant variations in appropriate timely treatment were found within and across stages of diagnosis, confirming that sex and race differences in NSCLC treatment exist.

• Publisher: Lippincott Williams & Wilkins,Lippincott Williams & Wilkins, Inc,Lippincott Williams & Wilkins Ovid Technologies
• Subject: African Americans - ethnology / African Americans - statistics & numerical data / Aged / Aged, 80 and over / Carcinoma, Non-Small-Cell Lung - diagnosis / Carcinoma, Non-Small-Cell Lung - ethnology / Carcinoma, Non-Small-Cell Lung - therapy / Chemotherapy / Epidemiology / European Continental Ancestry Group - ethnology / European Continental Ancestry Group - statistics & numerical data / Female / Gender differences / Guideline Adherence - statistics & numerical data / Health care / Health insurance / Health Services Accessibility - statistics & numerical data / Health Services Research / Healthcare Disparities - statistics & numerical data / Humans / Insurance Claim Reporting - statistics & numerical data / Logistic Models / Lung cancer / Lung neoplasms / Lung Neoplasms - diagnosis / Lung Neoplasms - ethnology / Lung Neoplasms - therapy / Male / Median income / Medical treatment / Medicare / Medicare - statistics & numerical data / Men / Multivariate Analysis / Non small cell lung carcinoma / Patient Selection / Physicians / Practice Guidelines as Topic / Practice Patterns, Physicians' - statistics & numerical data / Prophets / Racial differences / SEER Program / Sensitivity and Specificity / Sex Factors / Sex linked differences / Socioeconomics / United States - epidemiology / White people / Women