Disparities in Lung Cancer Staging with Positron Emission Tomography in the Cancer Care Outcomes Research and Surveillance (CanCORS) Study

Abstract

Introduction Disparities in treatment exist for non-white and Hispanic patients with non-small-cell lung cancer, but little is known about disparities in the use of staging tests or their underlying causes. Methods Prospective, observational cohort study of 3638 patients with newly diagnosed non-small-cell lung cancer from 4 large, geographically-defined regions, 5 integrated health care systems and 13 VA health care facilities. Results Median age was 69 years, 62% were men, 26% were Hispanic or non-white, 68% graduated high school, 50% had private insurance, and 41% received care in the VA or another integrated health care system. After adjustment, PET use was 13% lower among non-whites and Hispanics than non-Hispanic whites (RR 0.87, 95% CI 0.77 to 0.97), 13% lower among those with Medicare than those with private insurance (RR 0.87, 95% CI 0.76 to 0.99), and 24% lower among those with an elementary school education than those with a graduate degree (RR 0.76, 95% CI 0.57 to 0.98). Disparate use of PET was not observed among patients who received care in an integrated health care setting, but the association between race/ethnicity and PET use was similar in magnitude across all other subgroups. Further analysis showed that income, education, insurance and health care setting do not explain the association between race/ethnicity and PET use. Conclusions Hispanics and non-whites with non-small-cell lung cancer are less likely to receive PET imaging. This finding is consistent across subgroups and not explained by differences in income, education, or insurance coverage.

Geographic and Sociodemographic Disparities in PET Use by Medicare Beneficiaries With Cancer

“…Our results, demonstrating lower use of PET among black beneficiaries compared with white beneficiaries, are consistent with these prior reports of racial disparities in the use of new technologies and, of note, also with the study of PET use in non–small-cell lung cancer in the Cancer Care Outcomes and Research Surveillance population [8]. …”

“…The importance of sociodemographic factors in PET use is important to examine given well-documented sociodemographic disparities in use of new technologies in general and, more specifically, on the basis of a recent study of PET use in patients with non–small-cell lung cancer. That study, using the Cancer Care Outcomes and Research Surveillance study population, found 13% lower use of PET among nonwhites and Hispanics compared to non-Hispanic whites after adjusting for income, education, insurance, and health care setting [8]. A national examination of sociodemographic patterns of PET use is compelling, particularly for cancers for which PET is covered by Medicare because that population accounts for the majority of cancers in the United States.…”

Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities

“…Moreover, the more affluent and educated are more likely to have a diagnostic confirmation of cancer, substantiating that socioeconomic factors do impact on the diagnostic workup. This is in keeping with multiple studies highlighting differences in cancer staging procedures between different racial/socioeconomic groups (Merrill et al , 2000; Gould et al , 2011) and among the elderly (Wedding and Lichtman, 2013). …”

Variations in Use of PET among Medicare Beneficiaries with Non–Small Cell Lung Cancer, 1998–2007

“…A previous analysis of PET (26) examined patients with NSCLC in the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) during the later phase of PET adoption between 2003 and 2005 and found a similar 10% differential use of PET according to race and education level. Our study examined regional measures of education, race, and income, whereas the CanCORS analysis used individuallevel metrics.…”