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

Abstract

BackgroundSmall cell lung cancer (SCLC) is associated with aggressive biology and limited treatment options, making this disease a historical challenge. The influence of race and socioeconomic status on the survival of stage IV SCLC remains mostly unknown. Our study is designed to investigate the clinical survival outcomes in Black and White patients with stage IV SCLC and study the demographic, socioeconomic, clinical features, and treatment patterns of the disease and their impact on survival in Blacks and Whites.Methods and ResultsStage IV SCLC cases from the National Cancer Database (NCDB) diagnosed between 2004 and 2014 were obtained. The follow-up endpoint is defined as death or the date of the last contact. Patients were divided into two groups by white and black. Features including demographic, socioeconomic, clinical, treatments and survival outcomes in Blacks and Whites were collected. Mortality hazard ratios of Blacks and Whites stage IV SCLC patients were analyzed. Survival of stage IV SCLC Black and White patients was also analyzed. Adjusted hazard ratios were analyzed by Cox proportional hazards regression models. Patients’ median follow-up time was 8.18 (2.37-15.84) months. Overall survival at 6, 12, 18 and 24 months were 52.4%, 25.7%, 13.2% and 7.9% in Blacks in compared to 51.0%, 23.6%, 11.5% and 6.9% in Whites. White patients had significantly higher socioeconomic status than Black patients. By contrast, Blacks were found associated with younger age at diagnosis, a significantly higher chance of receiving radiation therapy and treatments at an academic/research program. Compared to Whites, Blacks had a 9% decreased risk of death.ConclusionOur study demonstrated that Blacks have significant socioeconomic disadvantages compared to Whites. However, despite these unfavorable factors, survival for Blacks was significantly improved compared to Whites after covariable adjustment. This may be due to Blacks with Stage IV SCLC having a higher chance of receiving radiation therapy and treatments at an academic/research program. Identifying and removing the barriers to obtaining treatments at academic/research programs or improving the management in non-academic centers could improve the overall survival of stage IV SCLC.

Survival Differences by Comorbidity Burden among Patients with Stage I/II Non-Small-Cell Lung Cancer after Thoracoscopic Resection

“…The type of surgery was categorized based on prior literature [ 21 ]. Covariates were selected based on a priori knowledge regarding their associations with our exposure and outcome of interest as well as based on prior NCDB analyses [ 22 , 23 ].…”

Impact of Race on Outcomes of Advanced Stage Non-Small Cell Lung Cancer Patients Receiving Immunotherapy

“…Most of these advances are based on clinical trials underrepresenting ethnic minorities [ 8 , 9 ]. Black patients demonstrate a higher rate of stage IV cancer [ 10 ] and have a decreased 5-year survival rate [ 10 , 11 ] when compared to white patients. Black patients have a higher propensity to develop lung cancer at a younger age and with fewer pack-years of smoking [ 12 , 13 ].…”

“…There are known racial disparities in treatment reception in most cancers, and lung cancer is no exception [ 17 , 18 ]. Various factors contribute to barriers in care, such as the vicinity of treatment facilities [ 19 ], lack of transportation opportunities [ 19 ], lack of medical insurance [ 10 ], and medical mistrust [ 19 ]. These factors have been extensively reported in minority patients in comparison with their nonminority counterparts [ 20 ].…”