Date of Conferral

2018

Degree

Ph.D.

School

Public Health

Advisor

Aaron Mendelsohn

Abstract

Racial and ethnic disparities related to lung cancer treatments and outcomes are not fully understood but may be due to individual or institutional factors. Following established national cancer treatment guidelines may improve patients' quality of life, outcome to treatment, and facilitate the eradication of lung cancer. There are limited data on the real-world treatment of racial/ethnic groups with non-small cell lung cancer (NSCLC) according to clinical practice guidelines, therefore this population-based cohort study examined the receipt of first line treatment for advanced or metastatic NSCLC according to the National Comprehensive Cancer Network (NCCN) practice guidelines. The Social Cognitive Theory served as the framework as it focuses on individual cognitive influences and self-efficacy. A retrospective analysis of NSCLC patients (> 65 years) was conducted using the linked Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare. Logistic regression models were fit to evaluate the relationships between patient race/ethnicity and the receipt of treatment according to the guidelines within various clinical strata (e.g., histology type, stage of disease). There were no significant differences between Caucasians and African Americans in terms of treatment consistent with guidelines after controlling for other factors. One limitation to this study was the administrative nature of the Medicare database and the limited number of Hispanic patients. This research may contribute to positive social change by supporting a deeper understanding of factors that might influence NSCLC treatment selection. Public health initiatives to promote compliance with treatment guidelines can lead to better outcomes following medical treatments, especially for NSCLC.

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