NCDB-Generated Literature on Cancer Disparities

Data from the National Cancer Database (NCDB) has been an invaluable resource to research endeavors in cancer disparities. The array of pertinent variables, and wide geographic and demographic coverage has uniquely positioned the NCDB as a premier resource for research into disparities for various types of cancer. As we mark the centennial celebration of the Commission on Cancer (CoC) and one of its poster products, the NCDB, the 10 most highly cited literature on disparities published using NCDB data are worthy of highlight.

A number of studies using data from the NCDB have highlighted the significant disparities in cancer morbidity, survival, and access to optimal cancer care in blacks, Hispanics, uninsured and underinsured.^1-10 Among patients with invasive breast cancer treated with breast-conserving surgery, Parekh et al. showed that black and Hispanic patients were less likely to receive radiation therapy compared to white patients.¹⁰ In their study of patients with mycosis fungoides using the NCDB, Su et al. found that black patients had shorter overall survival (OS) compared to white patients after adjusting for socioeconomic status (SES), type of treatment received and disease characteristics.³ In the gynecologic oncology literature, Fader et al. reported late-stage presentation and poorer survival for Black women with endometrial cancer compared to white.⁴ In a cohort of patients with uterine cancer, Fedewa et al. found relatively poor survival among black patients compared to white patients with factors such as late-stage presentation, aggressive histology and lack of insurance or underinsurance being contributory factors.²

A number of informative studies in urologic oncology have utilized the rich data of the NCDB to elucidate disparities. Fedewa et al. found that uninsured and underinsured patients with prostate cancer were more likely to have poorly differentiated Gleason score.¹ A study by Maurice et al. showed that Black men with low-risk prostate cancer are more likely to harbor higher risk disease compared to non-black men. Another study by Gild et al reported lower quality of care for black patients with bladder cancer compared to white patients within the domains of timeliness to treatment, lymph node retrieval rate and frequency of pelvic lymph node dissection.^5,7 Among patients with penile squamous cell carcinoma (SCC), black race was associated with worse OS while private insurance and median income ≥ $63,000 predicted better OS in a study by Sharma et al.⁶

The Head and Neck (H&N) has been another disease site of fruitful disparities research using the NCDB. In their study of SCC of the H&N among black and white patients, Peterson et al. noted that black patients had a higher rate of advanced-stage disease at presentation and also had more aggressive non-oropharyngeal tumors while white patients had higher incidence of high-risk HPV types.⁹ Capitalizing on another strength of the NCDB which is its large sample size even for rare diseases, Carey et al. found that the uninsured, Medicare and Medicaid patients with sinonasal SCC had worse OS compared to privately insured patients.⁸ Carey et al. also reported a higher 30-day readmission rate among Hispanic patients compared to white patients.

The above studies represent a small sample of the many impactful studies utilizing the NCDB. With the investments in expert personnel and advanced informatics technology, it is anticipated that additional relevant variables, quality, and timely data will continue to be captured in the NCDB to further advance the field of cancer disparities research.

References

1. Fedewa SA, Etzioni R, Flanders WD, Jemal A, Ward EM. Association of insurance and race/ethnicity with disease severity among men diagnosed with prostate cancer, National Cancer Database 2004-2006. Cancer epidemiology, biomarkers & prevention: A publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2010; 19(10): 2437-44.
2. Fedewa SA, Lerro C, Chase D, Ward EM. Insurance status and racial differences in uterine cancer survival: a study of patients in the National Cancer Database. Gynecologic oncology 2011; 122(1): 63-8.
3. Su C, Nguyen KA, Bai HX, et al. Racial disparity in mycosis fungoides: An analysis of 4495 cases from the US National Cancer Database. Journal of the American Academy of Dermatology 2017; 77(3): 497-502.e2.
4. Fader AN, Habermann EB, Hanson KT, Lin JF, Grendys EC, Dowdy SC. Disparities in treatment and survival for women with endometrial cancer: A contemporary national cancer database registry analysis. Gynecologic oncology 2016; 143(1): 98-104.
5. Maurice MJ, Sundi D, Schaeffer EM, Abouassaly R. Risk of Pathological Upgrading and Up Staging among Men with Low Risk Prostate Cancer Varies by Race: Results from the National Cancer Database. The Journal of urology 2017; 197(3 Pt 1): 627-31.
6. Sharma P, Ashouri K, Zargar-Shoshtari K, Luchey AM, Spiess PE. Racial and economic disparities in the treatment of penile squamous cell carcinoma: Results from the National Cancer Database. Urologic oncology 2016; 34(3): 122.e9-15.
7. Gild P, Wankowicz SA, Sood A, et al. Racial disparity in quality of care and overall survival among black vs. white patients with muscle-invasive bladder cancer treated with radical cystectomy: A national cancer database analysis. Urologic oncology 2018; 36(10): 469.e1-.e11.
8. Carey RM, Parasher AK, Workman AD, et al. Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database. The Laryngoscope 2018; 128(3): 560-7.
9. Peterson CE, Khosla S, Chen LF, et al. Racial differences in head and neck squamous cell carcinomas among non-Hispanic black and white males identified through the National Cancer Database (1998-2012). Journal of cancer research and clinical oncology 2016; 142(8): 1715-26.
10. Parekh A, Fu W, Hu C, et al. Impact of race, ethnicity, and socioeconomic factors on receipt of radiation after breast conservation surgery: analysis of the national cancer database. Breast cancer research and treatment 2018; 172(1): 201-8.