NEW YORK, Oct 13 (Reuters Health) -- The lower rate of survival seen in blacks with non-small-cell lung cancer may be due to a lower rate of surgical treatment in black patients compared to white patients, according to a study in the October 14th issue of The New England Journal of Medicine.
"We cannot determine from our data why black patients have a lower rate of resection (surgery) than their white counterparts," write lead author Dr. Peter Bach and his colleagues, "but we can conclude that the difference in treatment has a substantial effect on survival."
Among cancers, lung cancer is the leading cause of death in the United States. If surgery is used as a treatment, the chance of living for five more years increases considerably, but if surgery is not performed, the average length of survival drops to less than one year.
The researchers note that about one third of patients with non-small-cell lung cancer, the most common type of lung cancer, are first diagnosed at an early, "potentially curable stage." Treated early with surgery, patients have a 40% chance of surviving for 5 years or longer.
Bach, based at Memorial Sloan-Kettering Cancer Center in New York City, and colleagues there and at the National Cancer Institute in Bethesda, Maryland, monitored the treatment of over 10,000 patients, 8% black and 92% white, with non-small-cell lung cancer between 1985 and 1993.
The research revealed that if blacks and whites with similar stages of the cancer received similar treatment, 5-year survival rates were similar -- about 43% for whites, 39% for blacks. However, the study also showed that whereas almost 77% of white patients had surgery, only 64% of black patients had an operation for lung cancer-- and this difference was associated with an increased 5-year survival in white patients.
Indeed, in a hypothetical group of 1,000 white patients, with about 77% having surgery, almost 43% of those having surgery and 5.2% not having surgery would survive for 5 years, estimate the researchers. In contrast, in a hypothetical group of 1,000 black patients, 7.7% fewer would survive to 5 years. The researchers attribute this difference to the lower surgery rate in blacks, and the slightly lower 5-year survival rate after surgery among black compared to white patients.
The investigators note that others "have argued that the preferences of black patients may differ from those of white patients or that black patients may weigh the risks of surgical therapy differently. An alternative explanation is that black patients are offered optimal treatment less frequently than their white counterparts." Bach and colleagues conclude that these issues "are certainly issues worthy of investigation in future studies."
In an accompanying editorial, Drs. Talmadge King and Paul Brunetta of the University of California, San Francisco, say the findings of this study and others "suggest that there is a difference in how physicians manage cancer that is based on a patient's race."
The editorialists say the blame for this falls on physicians for being ignorant of "established standards for the diagnosis... of lung cancer" and lack of communication between black patients and their physicians. In addition, blacks' mistrust of the healthcare system and their reluctance to enroll in clinical trials because of this play a role as well, King and Brunetta suggest.
They conclude that if patients are receiving substandard treatment because of racial discrimination, "then the medical establishment begins to share a portion of the tobacco industry's culpability for the dismal outcome of patients with this disease."
