Abstract PR06: Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011
Authors: Richards Thomas B. , Negoita Serban , McNeel Timothy S. , Holt Dylan L. , Topor Marie , Henley S Jane , White Arica , Li Jun , Li Chunyu 
Published: March 2017

Purpose: Anatomic pulmonary resection includes surgical procedures such as pneumonectomy, lobectomy, and segmentectomy, in contrast to non-anatomic pulmonary surgical procedures such as wedge resection. National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) indicate that anatomic pulmonary resection is preferred when surgery is indicated. The purpose of the current study is to describe racial-ethnic disparities in the receipt of anatomic pulmonary resection among NSCLC patients.

Methods: We analyzed Surveillance, Epidemiology, and End Results (SEER) patients linked with Medicare claims, first diagnosed in 2000-2011. We required patients to have NSCLC as their first malignancy and covered by fee-for-service with continuous Part A and B Medicare from 12 months before to 4 months after first diagnosis. We categorized stage using American Joint Committee on Cancer 6th Edition. We excluded patients who were age ≤65 years; diagnosed at occult stage or stage 0; diagnosed at death; had unknown race, census tract poverty, urban-rural status, month of diagnosis, or month of death; or were enrolled in a health maintenance organization at any time from 12 months before to 4 months after diagnosis. We used SEER race to classify cases as: non-Hispanic whites; non-Hispanic blacks; Hispanics of white or black race (hereafter referred to as Hispanics), and Asian or Pacific Islanders. We reserved cases with American Indian or Alaska Native race for a future, separate analysis because numbers were smaller compared to other racial-ethnic groups. We defined anatomic pulmonary resection to include pneumonectomy, lobectomy, and segmentectomy. We identified receipt of anatomic pulmonary resection from the month of diagnosis to 4 months after first NSCLC diagnosis using Healthcare Common Procedure Coding System and International Classification of Disease 9th edition Clinical Modification codes. We used multiple variable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for receipt of anatomic pulmonary resection by males, and separately by females, adjusting for age at diagnosis, racial-ethnic group, mediastinal exploration, stage, histology, census tract poverty, SEER region, year of diagnosis, and comorbidity.

Results: Our study cohort included 99,766 NSCLC cases, with similar proportions of males (51.2%) and females (48.8%). Overall, 23.2% (n=23,105) received anatomic pulmonary resection, but receipt varied by racial-ethnic group. Compared to non-Hispanic black men, anatomic resection procedures were more commonly received by men who were non-Hispanic white (aOR, 1.93; 95% CI, 1.70-2.19), Hispanic (aOR, 1.82; 95% CI, 1.49-2.22), or Asian or Pacific Islander (aOR, 2.06; 95% CI, 1.71-2.49). Compared to non-Hispanic black females, anatomic resection procedures also were more commonly received by females who were non-Hispanic white (aOR, 1.39; 95% CI, 1.23-1.57), Hispanic (aOR, 1.46; 95% CI, 1.20-1.79) or Asian or Pacific Islander (aOR, 1.42; 95% CI, 1.16-1.73).

Conclusions: Non-Hispanic black men diagnosed with NSCLC from 2000-2011 were less likely to receive anatomic pulmonary resection than non-Hispanic white, Hispanic, or Asian or Pacific Islander men. Non-Hispanic black females also were less likely to receive anatomic pulmonary resection, but the differences in aORs by race were smaller among females than among males.

Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR06.