Abstract
OBJECTIVE: Race-based disparities in lung cancer care are well described, such that Black patients face lower access to screening and early diagnosis, and inferior overall survival. We sought to examine race-based differences in referral to Commission on Cancer-accredited hospitals for pulmonary resection. METHODS: Within the National Cancer Database, we tabulated all patients aged 18 years or more of White or Black race diagnosed with stage IA non-small cell lung cancer who underwent definitive surgical resection from 2010 to 2022. Patients diagnosed at a separate institution from the operating facility were considered "referred," and those diagnosed and treated at the same center were considered "nonreferred." Hospitals in the top quartile by cumulative volume were considered high-volume centers (≥30 resections/year). RESULTS: Of 123,706 patients, 33,218 (27%) were referred for care. After risk adjustment, Black race remained associated with a lower likelihood of referral (adjusted odds ratio, 0.80, CI, 0.77-0.85). Moreover, among those referred, Black race was associated with reduced odds of referral for care at high-volume centers (adjusted odds ratio, 0.91, CI, 0.83-0.99). Referral for care was associated with a longer duration of waiting time from diagnosis to surgery (β + 28 days, CI, 28-29) and greater travel distance (β + 12 miles, CI, 11-13). Additionally, referral was linked with greater likelihood of receiving a minimally invasive operation and reduced odds of perioperative morbidity; referral to high-volume centers was associated with superior 5-year survival. CONCLUSIONS: Black patients faced a lower likelihood of referral for surgical care, reduced access to high-volume centers when referred, and longer waiting times from diagnosis to surgery. National efforts should seek to facilitate referral and ensure equitable access to high-quality care.