||5R01CA090226-03 Interpret this number
||Sloan-Kettering Inst Can Res
||Understanding Racial Differences-Lung Cancer Treatment
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
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.
The effect of clustering of outcomes on the association of procedure volume and surgical outcomes.
Panageas KS, Schrag D, Riedel E, Bach PB, Begg CB
Ann Intern Med, 2003 Oct 21;139(8), p. 658-65.