Race and sex differences in the receipt of timely and appropriate lung cancer treatment.
BACKGROUND
Previous research suggests that disparities in non-small-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.


METHODS
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.


CONCLUSIONS
Significant variations in appropriate timely treatment were found within and across stages of diagnosis, confirming that sex and race differences in NSCLC treatment exist.
Shugarman
Lisa R
LR
RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA. lisas@rand.org
Mack
Katherine
K
Sorbero
Melony E S
ME
Tian
Haijun
H
Jain
Arvind K
AK
Ashwood
J Scott
JS
Asch
Steven M
SM
D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008571:Men; D015999:Multivariate Analysis; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018426:SEER Program; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*; D014930:Women