Consortium Explores Racial Differences in Treatment and Toxicity in Patients With Non-Small Cell Lung Cancer Receiving Definitive Thoracic Radiotherapy
Black patients reported significantly greater general pain both before the initiation of radiation therapy and at the end of radiation therapy, according to an analysis of racial differences in thoracic radiation treatment and related toxicity in patients with non-small cell lung cancer (NSCLC; JCO Oncol Pract. 2022; doi:10.1200.OP.21.00224; published online February 15).
Previously reported racial disparity in lung cancer surgery rates, resulting in lower survival in Black patients, prompted the Michigan Radiation Oncology Quality Consortium to conduct this analysis. Its objective was to determine whether similar racial disparities existed in thoracic radiation treatment, chemotherapy, and related toxicities.
To make this determination, the consortium analyzed a Michigan statewide patient-level database of patients with stage II to III NSCLC who had definitive thoracic radiation from March 2012 to November 2019. The analysis included 1441 patients from 24 institutions, and the mean age of patients in the study group was 68 years (range, 38 to 94 years).
In this database, race was self-reported by the patients. Patient-reported toxicity was assessed by the responses patients provided on the Functional Assessment of Cancer Therapy–Lung quality-of-life instrument. Provider-reported toxicity was determined from provider reports made by using the Common Terminology Criteria for Adverse Events version 4.0.
Using these data, the consortium fitted univariable and multivariable regression models to evaluate the relation between race and variables of interest. In addition, Spearman rank-correlation coefficients were calculated to assess the association between provider-reported toxicity and related patient-reported outcomes.
From this analysis, the consortium found that race was not associated with the radiation therapy or chemotherapy approach used. However, its analysis revealed that Black patients were significantly less likely than White patients to have grade 2+ pneumonitis as reported by their provider (odds ratio, 0.36; P=0.03). This finding held true even after known patient and treatment factors had been controlled.
The consortium also found that correlation coefficients between provider-reported and patient-reported toxicities were similar across racial groups. However, in White patients, a stronger correlation was found between patient-reported and provider-reported esophagitis.
“In this large multi-institutional study, we found no evidence of racial differences in radiation treatment or chemotherapy approaches,” wrote Anna Mary Brown Laucis, MD, MPhil, Department of Radiation Oncology, Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, and colleagues. “We did, however, unexpectedly find that Black race was associated with lower odds of provider-reported grade 2+ radiation pneumonitis. The stronger correlation between patient- and provider-reported esophagitis and swallowing symptoms for White patients also suggests possible under-recognition of symptoms in Black patients. Further research is needed to study the implication for Black patients.”
