Reducing racial disparities and achieving health equity in lung cancer treatment among the underserved - 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.
