Survival Disparities in Non–Small Cell Lung Cancer by Race, Ethnicity, and Socioeconomic Status

Tannenbaum, Stacey L.; Koru‐Sengul, Tulay; Zhao, Wei; Mao, Feng; Byrne, Margaret M.

doi:10.1097/ppo.0000000000000058

Cited by 101 publications

(97 citation statements)

References 23 publications

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“…In our study, we have also demonstrated that race is significantly associated with the extent of lymph node evaluation, which is consistent with other studies that have demonstrated racial disparities of care in the treatment of lung cancer [34, 35]. We have additionally demonstrated that treatment at a high-volume center as well as at a center with an academic association are both associated with the extent of lymph node evaluation, which also corresponds to other studies that have demonstrated a survival benefit in lung cancer resection by treatment at academic and high volume centers [36].…”

Section: 0 Discussionsupporting

confidence: 92%

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer

et al. 2015

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Introduction Lymph node evaluation for node-negative non-small cell lung cancer (NSCLC) is associated with long-term survival but it is not clear if smaller tumors require as extensive a pathologic nodal assessment as larger tumors. This study evaluated the relationship of tumor size and optimal extent of lymph node resection using the National Cancer Data Base (NCDB). Materials and Methods The incremental survival benefit of each additional lymph node that was evaluated for patients in the NCDB who underwent lobectomy for clinical Stage I NSCLC from 2003–2006 was evaluated using Cox multivariable proportional hazards regression modeling. The impact of tumor size was assessed by repeating the Cox analysis with patients stratified by tumor size ≥2 cm vs <2 cm. Results A median of 7 [interquartile range: 4,11] lymph nodes were examined in 13,827 patients who met study criteria. Following adjustment, the evaluation of each additional lymph node demonstrated a significant survival benefit through 11 lymph nodes. After grouping patients by tumor size, patients with tumors <2 cm demonstrated a significant survival benefit for the incremental resection of each additional lymph node through 4 lymph nodes while patients with tumors ≥2 cm had a significant survival benefit through 14 lymph nodes. Conclusion Pathologic lymph node evaluation is associated with improved survival for clinically node-negative NSCLC, but the extent of the necessary evaluation varies by tumor size. These results have implications for guidelines for lymph node assessment as well as the choice of surgery versus other ablative techniques for clinical stage I NSCLC.

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Section: 0 Discussionsupporting

confidence: 92%

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer

et al. 2015

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“…Patients treated at academic centers were more likely to be Black (African American), Asian, or Hispanic. Asians with NSCLC have improved OS due to difference in disease biology such as increased prevalence of epidermal growth factor receptor (EGFR) mutation . A California Cancer Registry study showed improved NSCLC‐specific mortality among foreign‐born Hispanics compared to non‐Hispanic Whites and Hispanics born in United States .…”

Section: Discussionmentioning

confidence: 99%

Survival trends among non‐small‐cell lung cancer patients over a decade: impact of initial therapy at academic centers

et al. 2018

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BackgroundTreatment of non‐small‐cell lung cancer (NSCLC) has been rapidly advancing over the last decade. Academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported.MethodsThe National Cancer Database (NCDB) was used to identify NSCLC incident cases from 2004 to 2013. Overall survival (OS) was plotted by year of diagnosis and type of initial treatment center, accounting for several factors available in NCDB.ResultsA total of 1 150 722 NSCLC patients were included and separated by initial treatment center type (academic: 31.5%; nonacademic: 68.5%). Median follow‐up and OS for all patients were 11.8 months (range: 0‐133.6 months) and 13.1 months (95% CI: 13.08‐13.17), respectively. Median OS improved significantly for those diagnosed in 2010‐2013 (14.8 months [95% CI: 14.7‐14.9]) as compared to 2004‐2009 (12.4 months [95% CI: 12.3‐12.5]) (P < 0.001). Treatment at academic centers was associated with improved OS (multivariate HR for OS = 0.929 [95% CI: 0.92‐0.94], P < 0.0010). Four‐year OS for academic and nonacademic cohorts was 28.5%% and 22.1%, respectively (P < 0.001), and the difference was more pronounced in stage I to III NSCLC.ConclusionIn this largest analysis, thus far, NSCLC survival has improved over time, and type of initial treatment center significantly influences survival. Identifying and removing barriers to obtaining initial treatment of NSCLC at academic medical centers could improve OS.

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“…Beyond racial disparities, socioeconomic status (SES), as measured by income level or degree of education, also recently was associated with multiple poor health outcomes, including diabetes, cardiovascular disease, and cancer . Population cohort studies in lung and esophageal cancers have suggested that one's social environment, as defined by area‐based socioeconomic measures, may be associated with worse survival outcomes, possibly due to poor screening or receipt of therapy . Such class disparities ultimately may mitigate improvements in outcomes, and warrant further evaluation to identify root causes of poor health and inequalities.…”

Section: Introductionmentioning

confidence: 99%

Impact of socioeconomic status on survival for patients with anal cancer

Lin

Gold

Schreiber

et al. 2018

Cancer

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Survival Disparities in Non–Small Cell Lung Cancer by Race, Ethnicity, and Socioeconomic Status

Cited by 101 publications

References 23 publications

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer

Survival trends among non‐small‐cell lung cancer patients over a decade: impact of initial therapy at academic centers

Impact of socioeconomic status on survival for patients with anal cancer

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