Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer

Williams, Christina D.; Salama, Joseph K.; Moghanaki, Drew; Karas, Tomer Z.; Kelley, Michael J.

doi:10.1016/j.jtho.2016.05.030

Cited by 60 publications

(36 citation statements)

References 36 publications

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“…The lack of racial disparities in overall and causespecific survival among patients with early-stage lung cancer who receive care in the Veterans Affairs healthcare system further suggests that unequal access to health care may contribute to racial disparities in survival. 48 The lack of racial disparities in overall survival was also observed among participants randomized to the treatment arm (low-dose CT) in the multicenter randomized National Lung Screening Trial (NLST). 49 This observation in the NLST suggests that the increased access to health care that resulted from screening improved the management and treatment of chronic diseases for black trial participants.…”

Section: Discussionmentioning

confidence: 96%

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Soneji

Tanner

Silvestri

et al. 2017

Chest

102

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Section: Discussionmentioning

confidence: 96%

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Soneji

Tanner

Silvestri

et al. 2017

Chest

102

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“…Although other authors have reported similar results with better outcomes in Asian patients compared to Caucasian patients, 25,30 this topic remains controversial. [30][31][32][33] The higher proportion of oncogenic driver mutations found in Asian patients, [34][35][36] subsequently reflected in better efficacy outcomes with EGFR tyrosine kinase inhibitors (TKIs), [37][38][39][40][41] could explain these discrepancies. Finally, multivariate Cox regression analysis confirmed that female sex, age under 65 years and living with others were indeed prognostic factors for OS.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database

et al. 2020

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Background Lung adenocarcinoma (ADC) is the main cause of death related to lung cancer. The aim of this study was to identify poor prognostic factors for overall survival (OS) in patients with stage IV lung ADC in real‐world clinical practice. Methods Patients were selected from the Surveillance Epidemiology and End Results (SEER) database. Chi‐square bivariate analysis was used for the association of binary qualitative variables. A multivariate Cox regression analysis was performed to determine the impact of these prognostic factors on OS. Results A total of 46 030 patients were included (51.3% men, mean age 67.03 ± 11.6), of whom 41.3% presented with metastases in bone, 28.9% in brain, 17.1% in liver and 31.8% in lung. Patients with liver metastases presented with two or more metastatic sites more frequently than patients without liver metastases ( P < 0.001). Male sex (HR 0.78, 95% CI: 0.76–0.80), age ≥ 65 years (HR 1.37, 95% CI: 1.33–1.40), lack of family support (HR 0.80, 95% CI: 0.78–0.81) and presence of liver (HR 1.45, 95% CI: 1.40–1.50), bone (HR 1.21, 95% CI: 1.18–1.24) or brain metastases (HR 1.18, 95% CI: 1.15–1.21) were identified as poor prognostic factors for OS. Patients with liver metastasis showed the highest hazard ratio value ( P < 0.001). Conclusions The presence of liver metastases was the worst prognostic factor for patients with metastatic lung ADC. This factor should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy. Key points Significant findings of the study Regression analysis identified poor prognostic factors for overall survival. Factors were male sex, age ≥ 65 years, lack of family support and presence of liver, bone and brain metastases. Patients with liver metastasis showed the highest HR (HR = 1.45 95% CI: 1.40–1.50). This study included the highest number of adenocarcinoma patients analyzed so far ( N = 46 030). What this study adds The presence of liver metastases should be considered as a stratification factor for future studies evaluating new cancer treatments including immunotherapy.

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“…For example, one recent population‐based study of patients with early‐stage lung cancer who were diagnosed during 2004 through 2013 indicated that surgery was recommended less often for black patients than for patients from other racial/ethnic groups, and, as a result, 47% of black patients did not receive surgical treatment compared with 38% of Hispanics and whites and 34% of Asians . However, another recent study indicated that racial differences in the receipt of surgery were eliminated in 2010 for patients with early‐stage lung cancer who were treated at Veterans Affairs facilities, and there were subsequently no differences in survival between blacks and whites …”

Section: Selected Findingsmentioning

confidence: 99%

“…76 However, another recent study indicated that racial differences in the receipt of surgery were eliminated in 2010 for patients with early-stage lung cancer who were treated at Veterans Affairs facilities, and there were subsequently no differences in survival between blacks and whites. 77…”

Section: Selected Cancers Female Breastmentioning

confidence: 99%

Cancer statistics for African Americans, 2019

DeSantis

Miller

Sauer

et al. 2019

CA A Cancer J Clinicians

586

520

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In the United States, African American/black individuals bear a disproportionate share of the cancer burden, having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers. To monitor progress in reducing these inequalities, every 3 years the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors using data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics. In 2019, approximately 202,260 new cases of cancer and 73,030 cancer deaths are expected to occur among blacks in the United States. During 2006 through 2015, the overall cancer incidence rate decreased faster in black men than in white men (2.4% vs 1.7% per year), largely due to the more rapid decline in lung cancer. In contrast, the overall cancer incidence rate was stable in black women (compared with a slight increase in white women), reflecting increasing rates for cancers of the breast, uterine corpus, and pancreas juxtaposed with declining trends for cancers of the lung and colorectum. Overall cancer death rates declined faster in blacks than whites among both males (2.6% vs 1.6% per year) and females (1.5% vs 1.3% per year), largely driven by greater declines for cancers of the lung, colorectum, and prostate. Consequently, the excess risk of overall cancer death in blacks compared with whites dropped from 47% in 1990 to 19% in 2016 in men and from 19% in 1990 to 13% in 2016 in women. Moreover, the black‐white cancer disparity has been nearly eliminated in men <50 years and women ≥70 years. Twenty‐five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths. Continued progress in reducing disparities will require expanding access to high‐quality prevention, early detection, and treatment for all Americans.

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Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer

Cited by 60 publications

References 36 publications

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival

Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database

Cancer statistics for African Americans, 2019

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