Provider Bias in Decision Making About Treatment of Early-stage Lung Cancer With Stereotactic Body Radiation Therapy or Sub-lobar Resection.

[INTRODUCTION:] Stereotactic body radiation therapy (SBRT) and sub-lobar resection are treatment options for patients deemed high-risk for lobectomy for early-stage non-small cell lung cancer (NSCLC). Disparities in surgical management of NSCLC are well-documented. We evaluated whether patient race or ethnicity influenced physicians’ therapeutic plans for early-stage NSCLC patients at high risk for lobectomy.

[METHODS:] Stage I-IIA NSCLC patients at high risk for lobectomy, treated with sub-lobar resection or SBRT, were recruited from five healthcare systems. Treating providers were interviewed pre-treatment to rate each patient’s probability of ideal candidacy for sub-lobar resection and likelihood of receiving a surgical recommendation. Generalized linear mixed models (random provider intercept) assessed associations between patient race/ethnicity and provider ratings, adjusted with inverse probability treatment weighting.

[RESULTS:] 337 patients (63% treated with SBRT) and 33 providers were enrolled. In adjusted analysis, Black race was not associated with lower odds of moderately ideal (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 0.48 to 5.28) or highly ideal (OR: 0.58, 95% CI: 0.09 to 3.61) candidacy for sub-lobar resection vs. white patients. Hispanic ethnicity predicted greater odds of moderately ideal (OR: 5.95, 95% CI: 1.54 to 23.05) but not highly ideal candidacy (OR: 3.8, 95% CI: 0.66 to 21.85). Neither Black race nor Hispanic ethnicity were associated with provider recommendation for sub-lobar resection.

[DISCUSSION:] We found that patient race or ethnicity were not associated with provider assessment of ideal candidacy for sub-lobar resection or recommendation for surgery. System- and patient-level factors may preferentially drive surgical inequities in early-stage NSCLC.