Socioeconomic factors influence OS in NSCLC
According to an expert, race and specific socioeconomic factors such as insurance, income, education and location influence the outcome of patients with non-small cell lung cancer (NSCLC).
The overall survival (OS) of patients with NSCLC was found to be associated with various socioeconomic factors and race, said Dr Yanyan Lou, a medical oncologist and assistant professor at the Mayo Clinic, US. The median OS was higher for Asians and Hispanics, compared with whites and blacks. The duration difference between the highest OS—which was found in Asians—and the lowest OS—which was found in blacks—was approximately 7 months. A probable explanation for the racial difference in OS could be the varying racial genetic susceptibilities to lung cancer, she added. [IASLC WCLC 2017. Abstract OA06.05] Lou was speaking at the International Association for the Study of Lung Cancer (IASLC) 18th World Conference on Lung Cancer (WCLC), held recently in Yokohama, Japan.
As for socioeconomic factors, lower education levels, lower median income and uninsured status were linked to worse outcomes. Other factors such as a higher rate of comorbidity, advanced stage of lung cancer and treatment at a community or low-volume centre, were also associated with worse outcomes.
The researchers assessed the demographic and clinical feature, and overall survival of patients with NSCLC. Information was obtained from the National Cancer Database (NCDB); data from a total of 1.1 million patients from 2004 to 2013 were analyzed. The majority of the patients (86.3 percent) were white, 10.9 percent were blacks and Asians plus Hispanics make up a small minority. Income was evenly distributed and majority of patients (97.7 percent) were insured. Most patients stayed in a metropolitan area.
Median age at diagnosis was 68.3 years old. Nearly half of the patients had stage 4 NSCLC upon diagnosis. Forty percent underwent radiotherapy and 30 percent had surgery of the primary site.
The study findings are similar to the findings of an older study published in The Cancer Journal in 2014, which involved a smaller cohort of 98,541. [2014;20(4):237–245] This latest study presented at the IASLC WCLC 2017 is the largest study of its kind and suggests a need for physicians to include socioeconomic status and race during the formation of management plan to ensure optimal outcomes for patients with NSCLC. “Our findings indicate that improving outcomes for NSCLC patients doesn’t solely rely on advancements in medicine, but also on ensuring more equitable health care delivery,” said Lou.