Disparities in Rates of Curative Surgery for NSCLC Vary by State

The likelihood of patients with early stage non-small cell lung cancer undergoing curative-intent surgery varies.
The likelihood of patients with early stage non-small cell lung cancer undergoing curative-intent surgery varies.

ATLANTA, GA—The likelihood of patients with early stage non-small cell lung cancer (NSCLC) undergoing curative-intent surgery varies substantially across the United States.

This data was presented at the Eighth American Association for Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.1

The National Cancer Institute reports that lung cancer is the second most common type of cancer and the leading cause of cancer deaths in men and women in the United States, with NSCLC the most common type of lung cancer. NSCLC is potentially curable by partial or whole lung resection in the early stage, when the disease is localized.

In this study, Helmneh M. Sineshaw, MD, MPH, senior epidemiologist and health services researcher with the American Cancer Society in Atlanta, Georgia, and colleagues sought to measure the extent of variations in receiving curative surgery for early stage NSCLC across the US states. They also examined whether racial disparity varies by state.

Using population-based cancer registries compiled by the North American Association of Central Cancer Registries, the researchers collected data on patients with stage 1 or 2 NSCLC diagnosed between 2007 and 2011 in 38 states and the District of Columbia.

The researchers chose Massachusetts, in which the rate of receipt of curative surgery was the highest at 75%, was chosen as the standard of comparison for all states. The rate was also seen in two other states: New Jersey and Utah.

Compared with Massachusetts, the lowest likelihood of receipt of curative surgery was in Wyoming (25% less likely to receive curative surgery); next largest gaps in which patients were less likely to receive curative surgery were in Oklahoma (20%), New Mexico (19%), Colorado (17%), Louisiana (17%), and Texas (16%).

Data on race was also evaluated to determine whether disparities persisted. All states/registries showed that non-Hispanic blacks were less likely than non-Hispanic whites to undergo surgery, with significant disparities after adjusting for socioeconomic factors and clinical characteristics in only two states.

In Florida, non-Hispanic blacks were 12% less likely than non-Hispanic whites to undergo curative surgery; in Texas, non-Hispanic blacks were 11% less likely than their non-Hispanic white counterparts.

Study limitations included that the study did not examine patient/physician communication and did not control for comorbidity.

Although some disparities can be explained by geography (states with major medical centers had higher rates of patients undergoing surgery), Sineshaw said further standardization of health care coverage could narrow the disparity.

“We do not have a uniform quality of health care in this country,” said Sineshaw. “Curative surgery for NSCLC is one example, with disparities in health care across population subgroups.”


1. American Association for Cancer Research. Receiving curative lung cancer surgery varies by state [news release]. EurekAlert! web site. http://www.eurekalert.org/pub_releases/2015-11/aafc-rcl111115.php. Accessed November 13, 2015.

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