UNDERSTANDING RACIAL DIFFERENCES--LUNG CANCER TREATMENT

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Disparities in care among black and white patients have been documented for a number of chronic medical conditions. Dr. Bach proposes a project designed to evaluate several potential mechanisms underlying this observed phenomenon. Black patients with Stage I/II (early stage) non-small cell lung cancer (NSCLC) are less likely than white patients to undergo curative surgical resection. This disparity in treatment accounts for the majority of the survival gap that currently exists between these racial, ethnic groups, and is consistent with racial disparities observed for a number of other serious medical conditions. At present, the underlying causes for these disparities remain uncertain. The objective of this study is to use treatment of early stage NSCLC as a model for understanding the reasons why black patients undergo potentially curative treatment for serious medical conditions at lower rates than similar white patients. Identifying the underlying mechanisms of these disparities should facilitate the design of effective interventions. This hypothesis driven study addresses the supposition that black patients undergo surgery at lower rates for two reasons: one physician based, one patient based. First, physicians evaluate risk of surgery less aggressively in blacks and therefore recommend surgery less often. Second, a black patient is less likely to accept a physician's recommendation if that physician is not racially concordant with him. The study will use the SEER-Medicare linked database, augmented by provider specific information gleaned from the American Medical Association provider file and the National Claims History file. The database will be used to identify the paths of evaluation followed by black and white patients with early stage NSCLC. Once identified, differences in the evaluative process undergone by black and white patients will be assessed, and the association between provider and patient race on receipt of surgery will be tested.