The Effect of Socioeconomic Status on Treatment and Mortality in Non-Small Cell Lung Cancer Patients

Ebner, Peggy J.; Ding, Li; Kim, Anthony W.; Atay, Scott M.; Yao, Mimi J.; Toubat, Omar; McFadden, P. Michael; Balekian, Alex; David, Elizabeth A.

doi:10.1016/j.athoracsur.2019.07.017

Cited by 45 publications

(49 citation statements)

References 30 publications

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“…Indeed, 89.6% of participants in the NLST were White and of higher socioeconomic status (SES) than the general population, 8,12 and these important demographic factors were not reported for the NELSON trial. 10 As such, the results from these landmark trials may not be generalizable to other groups, such as Black and socioeconomically disadvantaged individuals, who have: 1) a higher incidence of NSCLC, [13][14][15][16][17][18] 2) higher mortality from NSCLC, 15,16,17,19,20,21 3) lower rates of treatment, [22][23][24][25][26][27][28][29][30] and 4) a greater chance of being diagnosed at advanced stages of the disease. 31,32 Eighty-five percent of lung cancers result from tobacco smoking, 33 so the finding that such strong tobacco marketing efforts were historically directed at members of marginalized and underserved communities must be highlighted, 34 especially because these same groups have the highest incidence and mortality from the disease.…”

Section: Introductionmentioning

confidence: 99%

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Sosa

D'Souza

Akhtar

et al. 2021

CA A Cancer J Clinicians

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Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.

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Section: Introductionmentioning

confidence: 99%

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Sosa

D'Souza

Akhtar

et al. 2021

CA A Cancer J Clinicians

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“…15,16 In the setting of cancer, low income is associated with inferior survival among both children 17 and adults. 18 Insurance status may also affect patient outcomes, as previous investigations have revealed that individuals with government-funded insurance are less likely to undergo curative therapy than those with private insurance. 10 The preponderance of the evidence indeed suggests that health care outcomes vary significantly based on immutable demographic and sociodemographic variables.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

et al. 2020

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Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

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“…In addition, several studies have described disparities in the use of LDCT screening in underserved populations, including racial/ethnic minorities (11,12), those living in rural areas with more limited access to care (13), and other vulnerable populations (14,15). Efforts to understand disparities in LDCT screening and their contributing factors have become increasingly relevant, as previous studies have shown that these same underserved populations have a greater incidence of lung cancer and are less likely to receive appropriate treatment (16)(17)(18)(19). Therefore, the objective of the present narrative review is to discuss lung cancer screening disparities in underserved populations and to examine methods of improving access to lung cancer screening in these patients.…”

Section: Review Articlementioning

confidence: 99%

“…Racial and ethnic disparities are well described in the thoracic oncology literature. In particular, several previous studies have shown that underrepresented minority populations experience a higher incidence of lung cancer and are less likely to receive guideline concordant treatment at various stages of disease (16,18,19,(24)(25)(26). Recently, there has been accumulating evidence to suggest that this pattern of racial disparities may extend into the receipt of LDCT screening (Table 2).…”

Section: Race/ethnicitymentioning

confidence: 99%

A narrative review of lung cancer screening in underserved populations

Toubat¹,

David²

2021

Curr Chall Thorac Surg

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Lung cancer screening with low-dose computed tomography (LDCT) is an effective approach for the early detection of lung cancer and the reduction of lung cancer specific mortality in high risk individuals. Despite recommendations for LDCT screening by the National Comprehensive Cancer Network (NCCN) and the United States Preventive Services Task Force, the utilization of LDCT screening in clinical practice has been low. Moreover, significant disparities in the use of LDCT have been described in underserved populations, including African American or black patients, rural patients with limited access to LDCT screening facilities, and other vulnerable patient groups with known risk factors for developing lung cancer. Several patient, provider, and healthcare systems level approaches have been proposed to mitigate lung cancer screening disparities. Such approaches include raising awareness of LDCT screening benefits and the evidence in support of LDCT screening among healthcare providers, educating patients on LDCT screening and optimizing shared decision-making approaches between patients and providers, and expanding patient access to LDCT screening through free and mobile lung cancer screening programs. As lung cancer screening utilization continues to expand in clinical practice, it will be critical to continue investigating the trends, causes, and outcomes of LDCT screening disparities in underserved populations.

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The Effect of Socioeconomic Status on Treatment and Mortality in Non-Small Cell Lung Cancer Patients

Cited by 45 publications

References 30 publications

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

A narrative review of lung cancer screening in underserved populations

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