Surgical Decisions for Early Stage, Non–Small Cell Lung Cancer: Which Racially Sensitive Perceptions of Cancer Are Likely to Explain Racial Variation in Surgery?

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Abstract
Objectives. Twenty-three percent of white and 36% of African American patients who suffer from early stage non–small cell lung cancer do not undergo potentially curative surgery. A simple decision model is presented to probe for elements of surgical decision making that could explain decisions against lung cancer surgery and racial variation in these decisions. Methods. A survey of 181 diverse individuals to measure health utility scores for conditions relevant to lung cancer surgery was performed. These scores were inserted into a simple model that calculates quality-adjusted survival related to decisions for and against cancer surgery. Results. The health utility score (HUS) for progressive lung cancer, as determined by a survey using the standard gamble approach, is nearly twice as high in African Americans as whites (0.32 v. 0.18). However, in a model incorporating African American utility data, lung cancer surgery remains heavily favored compared to the no-surgery decision (2.32 v. 0.48 quality-adjusted life years). Sensitivity analysis shows that factors that lead to a belief of cancer “cure” in the absence of surgical intervention are much more important than variations of HUS in directing model results away from surgery. Conclusion. This analysis illustrates that racial differences in quality-of-life ratings of progressive lung cancer as measured by HUS exist but may not explain decisions against surgery as much as other elements of patient care.