NSCLC Outcomes Improve, but Racial, Ethnic Disparities Remain

A new analysis of non–small cell lung cancer (NSCLC) outcomes in the United States suggests that racial and ethnic disparities have been narrowing in recent years but that significant disparities remain.

The findings were published JTO Clinical and Research Reports.

The authors said the big picture in NSCLC is that mortality rates have seen significant decreases. However, they said certain demographic groups have continued to face comparatively poor outcomes.

“For example, Black men experience higher lung cancer incidence and mortality rates than White counterparts,” they said. “Furthermore, people of color have been shown to develop cancer at earlier ages than White individuals and are more likely to present with advanced-stage disease at diagnosis.”

In 2013, the US Preventive Services Task Force recommended annual low-dose CT screening for people considered to be at high risk of lung cancer. However, despite coverage by private insurers and Medicare since 2015, coverage for screening for patients on Medicaid varies from state to state, the authors noted.

“Treatment of NSCLC has also changed in the past decade, with the identification of specific driver mutations and the development of molecularly targeted therapies and immunotherapies for NSCLC,” they wrote. Access to those therapies depends on insurance coverage, and the authors noted that certain demographic groups are more likely to be uninsured or underinsured.

In light of treatment and screening advances, the investigators wanted to see how NSCLC outcomes have changed and whether those changes varied among racial and ethnic groups. They used the National Cancer Institute’s Surveillance, Epidemiology, and End Results database to identify patients aged 55 to 79 years who received a NSCLC diagnosis between 2007 and 2018. Overall and stage-specific 2-year cause-specific survival (CSS) rates were compared by sex and race/ethnicity, and disparities in those results were tracked over time.

The overall incidence of NSCLC dropped significantly over the time span in both men and women, the authors said, due largely to declines in the incidence of distance-stage NSCLC. In men, annual all-stage incidence dropped by an average of 3.35%. Among women, the average annual percentage change was 1.92%. Local-stage NSCLC increased among Black and Hispanic women but was stable across other groups. Yet, while the absolute disparities (representing the range between the group with the highest and lowest rates) have decreased for both men and women, relative disparities (calculated by dividing the highest rate by the lowest rate) have not.

“[R]elative disparities in overall and stage-specific NSCLC incidence remained constant over time, indicating that more work is needed to not only reduce but eliminate disparities in NSCLC outcomes across groups,” they wrote.

In particular, the authors said, the gap between Black men and White men has persisted, with NSCLC incidence remaining 33% higher among Black men vs White men at the end of the study period.

Likewise, 2-year CSS rates improved across the board, driven by improved outcomes for patients with diagnoses that involve regional and distant stages. Overall, 2-year survival rates increased annually by an average of 2.97% and 2.60% for men and women, respectively. Still, racial and ethnic disparities persisted. Hispanic men and women had the highest overall 2-year CSS, while Black men and women had the lowest.

The authors said the overall improvement is the result not only of improved therapies, but also better screening and detection. They added, however, that those improvements will only have an impact on disparities if they are equitably accessible.

“More work is needed to identify and implement interventions to ensure consistent and equitable use of high-quality screening, diagnosis, and treatment to reduce and eliminate persistent racial and ethnic disparities,” they concluded.

Reference

Primm K, Zhao H, Hernandez D, Chang S. Racial and ethnic trends and disparities in non-small cell lung cancer. JTO Clin Res Rep. 2022:100374. doi:10.1016/j.jtocrr.2022.100374