US healthcare: Black people less likely to receive lung cancer chemotherapy

Boston Medical Center researchers found that Black individuals, above all other racial groups, are less likely to receive lung cancer chemotherapy

A new study by researchers at Boston Medical Center found that Black individuals with extensive-stage small cell lung cancer are less likely to get chemotherapy, than all other racial groups. The most likely group to miss out on this treatment are those who are Black and elderly. In addition, these individuals are likely to be uninsured or to have non-private health insurance and lower education levels.

This is one of the largest studies to investigate racial and health disparities in this field, including the unique impact that insurance status has on cancer care in the US.

Lung cancer is the leading cause of cancer death for men and women. It is estimated that 135,720 deaths from this disease will occur in 2020.

Extensive-stage small cell lung cancer has the unfortunate tendency to rapidly grow – meaning that treatment as soon as possible is the most recommended way to give the patient a chance at survival. The cost of lung cancer over a lifetime is estimated by a 2017 Milliman Research Report to be around $282,000 – almost twice as expensive as the estimated cost of breast cancer at $101,000, or roughly seven times as expensive as melanoma at $48,013.

The cost of lung cancer over a lifetime is estimated by a 2017 Milliman Research Report to be around $282,000

82,592 lung cancer patients analysed

The analysis of 82,592 lung cancer patients showed that chemotherapy was given to 92.1% of patients. Insurance and income status played a large role in treatment and survival of patients. Black patients were more likely to be uninsured or have public health insurance compared to white and other race groups, and patients with non-private insurance or without insurance were less likely to receive chemotherapy treatment. Private insurance was associated with the highest survival of 9.2 months, followed by patients with Medicaid at 8.3 months. Lower income is associated with worse survival, which has been found for all lung cancer diagnoses.

Healthcare disparities across socio-economic lines

“Our study highlights the disparities that can exist in healthcare, and the impact that race and socioeconomic status can have on a patient’s experience throughout their treatment,” says Umit Tapan, MD, a thoracic oncologist at Boston Medical Center and the study’s corresponding author.

“While our study looked specifically at patients with extensive-stage small cell lung cancer, our results further demonstrate the impact that socioeconomic status can have on the health of patients, whether it be access to treatment or their outcomes.”

A highly-political impact of healthcare policy can be seen in this research. During 2010 to 2016, Black patients had a higher chance of receiving chemotherapy than in 2004 to 2006. The authors suggest that the Patient Protection and Affordable Care Act (ACA) in 2010 marked this uptake of the expensive chemotherapy that is almost essential to surviving this form of lung cancer.

A study published in JAMA Oncology in 2020 found that Medicaid expansion under the ACA in 2014 “substantially reduced the numbers of uninsured patients with cancer, and increased early-stage diagnoses of cancers.” Whilst noting an increased percentage of early-stage diagnoses, the team are still waiting to understand how the expansion impacted lung cancer survival rates.

Further research is necessary, but read the available study here.