Abstract B80: Race and impact of comorbidities and time to care on receipt of surgery for early-stage non-small cell lung cancer
Authors: Williams Christina D. , Provenzale Dawn , Kelley Michael 
Published: June 2012

Abstract
Background: Lung cancer is the leading cause of cancer-related deaths. In the Veterans Health Administration (VHA), lung cancer represents 20% of incident cancer cases each year. Non-small cell lung cancer (NSCLC) is the most common type, accounting for 88% of all lung cancer diagnoses. Early stage (Stage I/II) NSCLC is potentially curable with surgical resection and surgery for early stage NSCLC is considered a quality indicator. In the VHA, it has been reported that Blacks were less likely to receive potentially curative surgery for NSCLC compared to Whites, as has been observed in non-VHA populations. Reasons for this disparity in an equal access health care system are unknown.
Objective: The objectives of this work were to: 1) examine the association between number of co-morbidities, performance status, and time-to-care intervals (abnormal imaging to diagnosis and diagnosis to surgery consultation) and receipt of surgery, and 2) determine if these associations differ between Whites and Blacks.
Methods: Data were from the External Peer Review Program (EPRP) Lung Cancer Special Study, a cross-sectional study conducted to assess the quality of care among patients diagnosed with lung cancer and receiving care at a VA facility. The study consisted of all incident lung cancer cases diagnosed between October 1, 2006 and December 31, 2007, and the analyses for this study were restricted to patients with early stage NSCLC (N=1603). All data were collected by reviewing electronic health records. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI).
Results: Patients with ≥3 co-morbidities compared to those with no co-morbidities were less likely to receive surgery (OR: 0.56, 95% CI 0.34–0.91) as well as those with poor performance status compared to those without poor performance status (OR: 0.21, 95% CI 0.14–0.31). In race-specific analyses, 66% of Whites had surgery and only 44% of Blacks had surgery (p=0.02). The number of co-morbidities, median time between abnormal imaging and diagnosis, and median time between diagnosis and consultation with a thoracic surgeon were similar between Blacks and Whites. Blacks had a significantly higher prevalence of poor performance status compared to Whites (14% versus 9%, p=0.0008). Among Blacks, the OR for patients with at least 3 co-morbid conditions was 0.18 (95% CI 0.04–0.85) compared to those with no co-morbidities, while the respective OR in Whites was not statistically significant. Having poor performance status was associated with lower probability of having surgery among both Blacks and Whites (OR: 0.12, 95% CI 0.04–0.39 in Blacks; OR: 0.23, 95% CI 0.15–0.37 in Whites). Patients with time intervals greater than or equal to the median time between abnormal imaging and diagnosis (i.e. 48 days) were more likely to receive surgery compared to those with less than the median time interval. The corresponding ORs among Blacks and Whites were 1.52 (95% CI 1.17–2.00) and 1.91 (95% CI 1.02–3.57).
Conclusion: Our findings suggest that the impact of co-morbidities, performance status, and time-to-care intervals are important predictors of receiving surgery for early stage NSCLC and these associations may differ by race.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B80.