Lung Cancer Treatment Disparities Persist for Black Patients

The persistent gap in curative treatment access for early-stage lung cancer between white and Black Medicare beneficiaries—a disparity first documented in the 1990s—continues to narrow at a frustratingly slow pace, according to new research published this month. The analysis, appearing in JAMA Network Open, underscores systemic inequities in cancer care despite decades of focused attention and evolving treatment options.

A Long-Standing Disparity

Researchers at Yale School of Medicine re-examined treatment patterns among over 28,000 Medicare beneficiaries diagnosed with stage I or stage II non-small cell lung cancer (NSCLC) between 2005 and 2019. The study, led by postdoctoral research fellow Olivia F. Lynch, MD, MPH, found that white individuals consistently received curative treatment—surgery or stereotactic body radiation therapy (SBRT)—at a significantly higher rate than Black individuals. The difference remained substantial across multiple time periods: in 2017-2019, 86.8% of white patients received curative treatment compared to 78.4% of Black patients.

“Disparities in lung cancer treatment within the Medicare population have been documented since the early 1990s,” Dr. Lynch told Healio. “It is pretty striking that, more than 30 years later—despite national efforts to address this—the gap has narrowed exceptionally little.”

This finding echoes earlier operate by Dr. Cary P. Gross and colleagues, who in 2008 published research in Cancer showing lower rates of surgical resection among Black patients with early-stage lung cancer between 1992 and 2002. Despite efforts to address these disparities during that period, the gap persisted.

Surgical Access Remains a Key Factor

The new analysis revealed that differences in surgical treatment rates accounted for a large portion of the overall disparity. From 2017-2019, 53.1% of white patients underwent surgery, compared to just 43.7% of Black patients. While the use of curative treatment overall increased over the 15-year study period, the racial gap remained stubbornly consistent.

“To some, surgery may seem like a ‘quick fix,’ but it takes a huge toll on the body and can require a long recovery,” Lynch explained. “It is very important to make sure we are identifying optimal surgical candidates, but it is just as important to make sure we are applying the same rubric across all patients when we are making those decisions.”

The Role of Newer Therapies: SBRT

The study also examined the use of SBRT, a less invasive radiation therapy that has become increasingly common for early-stage NSCLC. Interestingly, the researchers found that initial disparities in SBRT utilization narrowed over time. From 2011-2013, when SBRT was first being adopted, only 39.6% of Black patients received the therapy compared to 51.6% of white patients. Still, as SBRT became more widely used and incorporated into treatment guidelines, the gap diminished.

“The fact that we saw racial disparities when SBRT was first being adopted is an important finding from our study,” Lynch said. “It is consistent with a pattern documented throughout medicine. When we develop new technologies, they reach some populations earlier than others, which is concerning.” You can find more information about SBRT from the American Cancer Society.

Beyond Insurance: Systemic Barriers

Because the study focused on Medicare beneficiaries, differences in insurance coverage cannot explain the observed disparities. This suggests that other systemic barriers within the healthcare system are at play. Lynch and colleagues point to potential factors such as referral patterns, access to specialized care and the availability of surgical services.

“Being able to control for that suggests other barriers in the health care system are contributing,” Lynch said. “This points to a larger systemic issue that goes beyond lung cancer—and even beyond cancer in general—and reflects structural inequities in our health care system that could have sweeping implications for the health and well-being of our entire population.”

Addressing Implicit Bias and Improving Access

The researchers emphasize the demand for multi-faceted strategies to address these disparities. System-level changes could include multidisciplinary tumor boards—where teams of specialists review each case—to ensure all treatment options are considered. Improvements to referral pathways, expanded access to surgical specialists, and patient navigation services could also play a role.

Clinicians, meanwhile, should be mindful of potential implicit biases and address social determinants of health—such as transportation and social support—that may impact a patient’s ability to access care.

“Whether we want to admit it or not, there is implicit bias in all of us,” Lynch said. “Notice subconscious conclusions we come to about patients we see. Paying attention to that, interrogating the biases that make us question whether a patient may not want—or may not benefit—from a specific treatment—and being mindful about applying rubrics equally to all patients are extremely important.”

What’s Next: Quality Improvement Initiatives

The study authors call for a shift from simply documenting disparities to actively implementing quality improvement initiatives. This includes developing targeted interventions to address specific barriers to care and monitoring outcomes to ensure equitable access to treatment. Further research is needed to understand the complex interplay of factors contributing to these disparities and to identify effective strategies for closing the gap. The National Cancer Institute provides information on cancer health disparities and ongoing research efforts.

“You can’t just continue documenting these concerning findings,” Lynch said. “At a certain point, we need to seize action. We need to take what we have learned, operationalize it and ask, ‘What initiatives can we create? What quality improvement projects…can we undertake to make change?’”

Olivia F. Lynch, MD, MPH, can be reached at [email protected].