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Zhou K, Shi H, Chen R, Cochuyt JJ, Hodge DO, Manochakian R, Zhao Y, Ailawadhi S, Lou Y. Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2032276. [PMID: 33433596 PMCID: PMC7804918 DOI: 10.1001/jamanetworkopen.2020.32276] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE It has been established that disparities in race and socioeconomic status are associated with outcomes of non-small cell lung cancer. However, it remains unknown whether this extends to stage I, II, or III small cell lung cancer (SCLC), or limited-stage SCLC (L-SCLC). OBJECTIVE To investigate the associations of race, socioeconomic factors, and treatment characteristics with survival among patients with L-SCLC. DESIGN, SETTING, AND PARTICIPANTS Demographic information for patients with L-SCLC diagnosed between 2004 and 2014 was obtained from the National Cancer Database. The follow-up end point is death or last follow-up (date of last contact). Patients were divided into 5 mutually exclusive cohorts by race. Data analysis was performed in October 2019. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to calculate univariable and multivariable models. Multivariable analyses were conducted to assess the associations of race and socioeconomic factors with risk-adjusted outcomes. Overall survival between groups was depicted by Kaplan-Meier curves. RESULTS Of 72 409 patients analyzed (median [range] age, 67.0 [23.0-90.0] years), 40 289 (55.6%) were women. The distribution of disease stage was 10 619 patients (14.7%) with stage I disease, 7689 patients (10.6%) with stage II disease, and 54 101 patients (74.7%) with stage III disease. The median (range) duration of follow-up was 8.2 (2.4-15.8) months. Compared with White patients, the hazard of death decreased to 0.92 (95% CI, 0.89-0.95; P < .001) for African American patients and 0.83 (95% CI, 0.77-0.91; P < .001) for Asian patients. The difference in median survival among different racial groups was significant only among those with stage III SCLC. Other factors associated with better survival were female sex, high income, high education, private insurance, diagnostic confirmation by positive cytological analysis, increase in number of sampled regional lymph nodes, and earlier stage at diagnosis. CONCLUSIONS AND RELEVANCE This analysis highlights disparities in race and socioeconomic factors associated with outcomes of L-SCLC. Racial minorities, including African American and Asian patients, have better survival than White patients for L-SCLC after adjustment for sociodemographic factors.
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Affiliation(s)
- Kexun Zhou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Huashan Shi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Ruqin Chen
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Jordan J. Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - David O. Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Rami Manochakian
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Yujie Zhao
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Yanyan Lou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
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Elkbuli A, Byrne MM, Zhao W, Sutherland M, McKenney M, Godinez Y, Dave DJ, Bouzoubaa L, Koru-Sengul T. Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry. Ann Med Surg (Lond) 2020; 60:680-685. [PMID: 33318793 PMCID: PMC7723764 DOI: 10.1016/j.amsu.2020.11.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies have revealed gender disparities in lung cancer survivorship, but comprehensive inclusion of clinical/individual variables which affect outcomes is underreported. We utilized the Florida Data Cancer System (FCDS) to examine associations between gender and lung cancer survivorship while controlling for prognostic variables on a large population-based scale. Methods A retrospective cohort analysis utilizing the FCDS, linked to Florida Agency for Health Care Administration and US Census Bureau tracts for patients diagnosed with primary lung cancer (n = 165,465) from 1996 to 2007. Primary outcome measures included median survival time and mortality. Multivariable Cox regression models, independent sample T-tests, and descriptive statistics were utilized with significance defined as p < 0.05. Results 165,465 cases were analyzed revealing 44.3% females and 55.7% males. The majority of patients were white/Caucasian, males, middle-high socioeconomic status, lived in urban areas, and geriatric age. Females had longer median survival compared to males (9.6 vs 7.1 months). Multivariable analyses showed that women had better survival after controlling for sociodemographic, clinical, and comorbidity covariates. Males had higher risk of mortality than females (aHR = 1.17, 95%CI 1.14-1.19, p < 0.01). Conclusions Individuals of higher socioeconomic status experienced greater survivorship compared to those of lower socioeconomic status. Women experienced significantly better survival for lung cancer at multiple time frames after controlling for covariates compared to men. Interventions aimed at public education and access to high-quality healthcare are needed to ameliorate socioeconomic and gender-based disparities in lung cancer survivorship. Future studies should investigate gender differences in lung cancer while incorporating individual socioeconomic status and treatment received.
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Affiliation(s)
- Adel Elkbuli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Margaret M Byrne
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Mason Sutherland
- Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Yeissen Godinez
- Department of Internal Medicine, Kendall Regional Medical Center, 11750 SW 40th St, Miami, FL, 33175, USA
| | - Devina J Dave
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA
| | - Layla Bouzoubaa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120, NW 14Street, Don Soffer Clinical Research Center, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
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Taioli E, Wolf AS, Moline JM, Camacho-Rivera M, Flores RM. Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma. DISEASE MARKERS 2015; 2015:282145. [PMID: 26063951 PMCID: PMC4430630 DOI: 10.1155/2015/282145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival. METHODS All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white). RESULTS There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted, p = 0.01). Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancer-directed surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77-0.88)) and early stage at diagnosis (HR 0.83 (0.76-0.90)) were predictive of longer survival in white, but not in black, patients. CONCLUSIONS Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY 11021, USA
| | - Andrea S. Wolf
- Department of Thoracic Surgery, Mount Sinai Medical Center, New York City, NY 10029, USA
| | - Jacqueline M. Moline
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY 11021, USA
| | - Marlene Camacho-Rivera
- Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY 11021, USA
| | - Raja M. Flores
- Department of Thoracic Surgery, Mount Sinai Medical Center, New York City, NY 10029, USA
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Efird JT, Landrine H, Shiue KY, O'Neal WT, Podder T, Rosenman JG, Biswas T. Race, insurance type, and stage of presentation among lung cancer patients. SPRINGERPLUS 2014; 3:710. [PMID: 25674451 PMCID: PMC4320244 DOI: 10.1186/2193-1801-3-710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/26/2014] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to determine whether African-American lung cancer patients are diagnosed at a later stage than white patients, regardless of insurance type. The relationship between race and stage at diagnosis by insurance type was assessed using a Poisson regression model, with relative risk as the measure of association. The setting of the study was a large tertiary care cancer center located in the southeastern United States. Patients who were diagnosed with lung cancer between 2001 and 2010 were included in the study. A total of 717 (31%) African-American and 1,634 (69%) white lung cancer patients were treated at our facility during the study period. Adjusting for age, sex, and smoking-related histology, African-American patients were diagnosed at a statistically significant later stage (III/IV versus I/II) than whites for all insurance types, with the exception of Medicaid. Our results suggest that equivalent insurance coverage may not ensure equal presentation of stage between African-American and white lung cancer patients. Future research is needed to determine whether other factors such as treatment delays, suboptimal preventive care, inappropriate specialist referral, community segregation, and a lack of patient trust in health care providers may explain the continuing racial disparities observed in the current study.
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Affiliation(s)
- Jimmy T Efird
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA ; Leo Jenkins Cancer Center, Brody School of Medicine, East Carolina University, Greenville, NC USA
| | - Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Kristin Y Shiue
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Wesley T O'Neal
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Tarun Podder
- Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Julian G Rosenman
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Tithi Biswas
- Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
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Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e278S-e313S. [PMID: 23649443 DOI: 10.1378/chest.12-2359] [Citation(s) in RCA: 887] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The treatment of stage I and II non-small cell lung cancer (NSCLC) in patients with good or low surgical risk is primarily surgical resection. However, this area is undergoing many changes. With a greater prevalence of CT imaging, many lung cancers are being found that are small or constitute primarily ground-glass opacities. Treatment such as sublobar resection and nonsurgical approaches such as stereotactic body radiotherapy (SBRT) are being explored. With the advent of minimally invasive resections, the criteria to classify a patient as too ill to undergo an anatomic lung resection are being redefined. METHODS The writing panel selected topics for review based on clinical relevance to treatment of early-stage lung cancer and the amount and quality of data available for analysis and relative controversy on best approaches in stage I and II NSCLC: general surgical care vs specialist care; sublobar vs lobar surgical approaches to stage I lung cancer; video-assisted thoracic surgery vs open resection; mediastinal lymph node sampling vs lymphadenectomy at the time of surgical resection; the use of radiation therapy, with a focus on SBRT, for primary treatment of early-stage NSCLC in high-risk or medically inoperable patients as well as adjuvant radiation therapy in the sublobar and lobar resection settings; adjuvant chemotherapy for early-stage NSCLC; and the impact of ethnicity, geography, and socioeconomic status on lung cancer survival. Recommendations by the writing committee were based on an evidence-based review of the literature and in accordance with the approach described by the Guidelines Oversight Committee of the American College of Chest Physicians. RESULTS Surgical resection remains the primary and preferred approach to the treatment of stage I and II NSCLC. Lobectomy or greater resection remains the preferred approach to T1b and larger tumors. The use of sublobar resection for T1a tumors and the application of adjuvant radiation therapy in this group are being actively studied in large clinical trials. Every patient should have systematic mediastinal lymph node sampling at the time of curative intent surgical resection, and mediastinal lymphadenectomy can be performed without increased morbidity. Perioperative morbidity and mortality are reduced and long-term survival is improved when surgical resection is performed by a board-certified thoracic surgeon. The use of adjuvant chemotherapy for stage II NSCLC is recommended and has shown benefit. The use of adjuvant radiation or chemotherapy for stage I NSCLC is of unproven benefit. Primary radiation therapy remains the primary curative intent approach for patients who refuse surgical resection or are determined by a multidisciplinary team to be inoperable. There is growing evidence that SBRT provides greater local control than standard radiation therapy for high-risk and medically inoperable patients with NSCLC. The role of ablative therapies in the treatment of high-risk patients with stage I NSCLC is evolving. Radiofrequency ablation, the most studied of the ablative modalities, has been used effectively in medically inoperable patients with small (< 3 cm) peripheral NSCLC that are clinical stage I.
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Affiliation(s)
- John A Howington
- NorthShore HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL.
| | - Matthew G Blum
- Penrose Cardiothoracic Surgery, Memorial Hospital, University of Colorado Health, Colorado Springs, CO
| | | | - Alex A Balekian
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
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Park ER, Japuntich SJ, Traeger L, Cannon S, Pajolek H. Disparities between blacks and whites in tobacco and lung cancer treatment. Oncologist 2011; 16:1428-34. [PMID: 21964005 DOI: 10.1634/theoncologist.2011-0114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Racial disparities exist in lung cancer incidence, morbidity, and mortality. Smoking is responsible for the majority of lung cancers, and racial disparities also exist in smoking outcomes. Black smokers are less likely than white smokers to engage in evidence-based tobacco treatment, and black smokers are less likely than white smokers to stop smoking. Continued smoking following a lung cancer diagnosis is a potential indicator of poor lung cancer treatment outcomes, yet lung cancer patients who smoke are unlikely to receive evidence-based tobacco treatment. The risks from continued smoking after diagnosis deserve attention as a modifiable factor toward lessening racial disparities in lung cancer outcomes.
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Affiliation(s)
- Elyse R Park
- Mongan Institute for Health Policy,Massachusetts General Hospital, Boston, Massachusetts, USA.
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