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Previous Volume 341:1198-1205 October 14, 1999 Number 16 Next

	Full Text PDF Editorial by King, T. E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background If discovered at an early stage, non–small-cell lung cancer is potentially curable by surgical resection. However, two disparities have been noted between black patients and white patients with this disease. Blacks are less likely to receive surgical treatment than whites, and they are likely to die sooner than whites. We undertook a population-based study to estimate the disparity in the rates of surgical treatment and to evaluate the extent to which this disparity is associated with differences in overall survival.

Methods We studied all black patients and white patients 65 years of age or older who were given a diagnosis of resectable non–small-cell lung cancer (stage I or II) between 1985 and 1993 and who resided in 1 of the 10 study areas of the Surveillance, Epidemiology, and End Results (SEER) program (10,984 patients). Data on the diagnosis, stage of disease, treatment, and demographic characteristics of the patients were obtained from the SEER data base. Information on coexisting illnesses, type of Medicare coverage, and survival was obtained from linked Medicare inpatient-discharge records.

Results The rate of surgery was 12.7 percentage points lower for black patients than for white patients (64.0 percent vs. 76.7 percent, P<0.001), and the five-year survival rate was also lower for blacks (26.4 percent vs. 34.1 percent, P<0.001). However, among the patients undergoing surgery, survival was similar for the two racial groups, as it was among those who did not undergo surgery. Furthermore, analyses in which adjustments were made for factors that are predictive of either candidacy for surgery or survival did not alter the influence of race on these outcomes.

Conclusions Our analyses suggest that the lower survival rate among black patients with early-stage, non–small-cell lung cancer, as compared with white patients, is largely explained by the lower rate of surgical treatment among blacks. Efforts to increase the rate of surgical treatment for black patients appear to be a promising way of improving survival in this group.

Source Information

From the Health Outcomes Research Group, Department of Epidemiology and Biostatistics (P.B.B., L.D.C., C.B.B.), and the Department of Medicine, Pulmonary Service (P.B.B.), Memorial Sloan-Kettering Cancer Center, New York; and the Applied Research Branch, National Cancer Institute, Bethesda, Md. (J.L.W.).

Address reprint requests to Dr. Bach at the Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 221, New York, NY 10021.

Full Text of this Article

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Racial Differences in the Treatment of Early-Stage Lung Cancer
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Extract | Full Text  
N Engl J Med 2000; 342:517-519, Feb 17, 2000. Correspondence

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