title: Disparities in treatment of patients with inoperable stage I non-small cell lung cancer: a population-based analysis.
abstract: BACKGROUND
  Patients unable to receive surgery for stage I non-small cell lung cancer (NSCLC) can undergo conventional radiotherapy (ConvRT), stereotactic body radiotherapy (SBRT), or no treatment (NoTx). This study assessed patterns of care and disparities in the receipt of each of these treatments.
  
  
  METHODS
  The study included patients in the National Cancer Database from 2003 to 2011 with T1-T2N0M0 inoperable lung cancer (n = 39,822). Logistic regressions were performed to determine predictors of receiving any radiation versus NoTx and for receiving SBRT versus ConvRT.
  
  
  RESULTS
  Treatment with radiation was significantly less likely in blacks (odds ratio, OR 0.65) and Hispanics (OR 0.42) compared with whites. Treatment with SBRT versus ConvRT was more likely in an academic research program (OR 2.62) and a high-volume facility (OR 7.00) compared with community cancer programs or low-volume facilities. In 2011, use of SBRT, ConvRT, and NoTx was 25%, 28%, and 46% for patients in a community cancer center versus 68%, 11%, and 21%, respectively, in an academic center (p < 0.0001).
  
  
  CONCLUSIONS
  There were marked institutional and socioeconomic variations in the treatment of inoperable stage I NSCLC. These results suggest that removal of barriers to receive radiation therapy and particularly improved access to SBRT may meaningfully improve survival in this disease.
authors.affiliation: *Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois; †Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois; ‡Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and §Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.forename: Renuka
authors.initials: R
authors.lastname: Malik
authors.forename: Mike
authors.initials: M
authors.lastname: Spiotto
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.forename: Ralph
authors.initials: R
authors.lastname: Weichselbaum
authors.forename: David
authors.initials: D
authors.lastname: Sher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000208:ethnology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult