Patterns of Care and Survival in Stage III NSCLC Among Black and Latino Patients Compared With White Patients

Background: Race and socioeconomic status have continued to affect the survival and patterns of care of patients with non–small-cell lung cancer (NSCLC). However, data evaluating these associations in patients with stage III disease remain limited. Therefore, we investigated the patterns of care and overall survival (OS) of black and Latino patients with locally advanced NSCLC compared with white patients, using the National Cancer Database. Materials and Methods: All patients with stage III NSCLC from 2004 to 2013 who had undergone external beam radiotherapy (RT) alone, RT with chemotherapy (bimodality), or RT with chemotherapy followed by surgery (trimodality) were analyzed within the National Cancer Database according to race (n = 113,945). Univariate associations among the demographic, disease, and treatment characteristics within the 3 cohorts were assessed using χ² tests. The OS between cohorts were analyzed using the log-rank test and multivariate Cox proportional hazards regression. Results: The black and Latino patients were younger at diagnosis, had lower median household incomes, and were less likely to be insured than were the white patients. The black patients were more likely to receive RT alone (19.3% vs. 18%; P <.001) and less likely to have undergone concurrent chemo-RT (53.6% vs. 56.1%; P <.001) compared with the white patients. Black patients had improved OS (P <.001). In contrast, the Latino patients had survival equivalent to that of the white patients (P =.920). Conclusions: Despite epidemiologic differences and a propensity for less aggressive treatment, black patients with locally advanced NSCLC had better OS than white patients and Latino patients had equivalent outcomes. Additional research is needed to elucidate this finding, perhaps focusing on biological differences among the cohorts.