PROJECT SUMMARY/ ABSTRACT
Lung cancer is the most lethal cancer and is responsible for 1.8 million deaths worldwide. Blacks are 15% less
likely to be diagnosed early, 10% more likely to not receive any treatment, and 12% less likely to survive 5
years compared to Whites. Overwhelmingly, there is enough proof that cancer treatments such as platinum-
based chemotherapy drugs, immunotherapy drugs, hormone treatment, anti-inflammatory drugs, combination
treatment, and anti-cancer agents, are effective in prolonging survival. In addition, delays, early termination of
treatments and early termination of treatment cycles occur among the elderly and increase mortality.
Furthermore, there may be important causal factors in relation to patient and provider characteristics that may
influence treatment success. However, we do not know how well it generalizes in terms of risks for survival to
Black non-small cell lung cancer (NSCLC) patients, a population with higher rates of lung cancer-specific and
all-cause mortality compared to Whites. Our long-term goal is to study the disparities in inequitable cancer
treatments and survival by educating clinicians. Our short-term goal is to document and communicate racial
inequities discovered to clinicians. Our main objective is to determine whether Black NSCLC patients are
receiving comparable cancer treatment to White NSCLC patients that can lengthen their survival. Our central
hypothesis is that there are racial disparities in receiving cancer treatment and treatment combinations, such
as chemotherapy plus immunotherapy that may improve survival. We will use the National Comprehensive
Cancer Network oncologic guidelines for NSCLC to determine standard treatment. To address our specific
aims, we will use a retrospective cohort study design and analyze our data using logistic and survival mixed
models. Our specific aims are to: 1) Determine racial disparities for receipt of cancer treatments, time to
receiving first single cancer treatment/treatment combinations, number of cycles and dose given in NSCLC; 2)
Determine the impact of time on lung-specific survival and overall survival; and 3) Investigate the bidirectional
intersectionality of causal factors in receiving treatment, delays in receiving first treatment, number of cycles,
and dose that impact racial disparities by stage, including patient characteristics (toxicities from cancer
treatments, histology, symptom burden, comorbidities, age, sex, insurance, SES levels, urban/rural area) and
provider characteristics (type of facility, hospital ownership, teaching status, location, and number of hospital
beds). Future studies will be aimed at investigating these Specific Aims in other minority groups, other types of
cancers for which Blacks have decreased survival, and translating the qualitative aspects of treatment
management in NSCLC patients.
