Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer

Abstract

IMPORTANCEIt 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.

Survival of Black and White Patients With Stage IV Small Cell Lung Cancer

“…This finding is consistent with our previous findings in non-small cell lung cancer (20). It is also found Black patients have superior survival compared to White patients with multiple myeloma, particularly due to diagnosis in the younger population (22,32).…”

“…This was similar to our previous study in NSCLC where we found the initial therapy at academic centers significantly improved clinical outcomes (20). Similarly, treatment at academic centers was also demonstrated independently associated with improved survival in patients with locally advanced head and neck cancer (22,33). The underlying factors driving the improved outcomes are likely multifactorial.…”

“…Kaplan-Meier analysis was used to compare survival differences between Blacks and Whites. Multivariable Cox regression modeling was used to identify independent features associated with survival in patients with stage IV SCLC and hazard ratios (HR) for mortality were presented (22). Nonproportional variables were used as stratification variables, and the proportional hazards assumptions were performed using Schoenfield residuals in the final analysis.…”

Impact of Socioeconomic Factors on Overall Survival in SCLC

“…A recent article investigated the demographic and treatment characteristics associated with outcomes in limited-stage SCLC, however, did not include patients with extensive-stage disease. 6 Given recent treatment advances, the impact that demographic factors have on patient outcomes for SCLC requires further evaluation. In this study, we determine how the demographics of SCLC have changed over time and evaluate whether patient demographics, disease presentation, and the treatment they receive affect patient outcomes for limited- and extensive-stage SCLC.…”

Demographic differentials of lung cancer survival in Bangladeshi patients

“…Among patient characteristics, performance status, comorbidity, and response to the treatment were also reported to influence patient survival [7,8]. Patient's demographic characteristics, such as gender [4,9,10] and race [11] have been linked with the treatment outcome and the survival in the recent literature, mostly from the western world. Despite, considerable evidence from the developed countries, the data is scarce in resource-limited countries like, Bangladesh.…”