Author of

• 11929

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  P2.22 - Poster Session 2 - Epidemiology, Etiology (ID 167)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11940

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    P2.22-011 - Racial/Ethnic Variation Among Non-Small Cell Lung Cancer (NSCLC) Patients in the United States Department of Defense (ID 2925)

    09:30 - 09:30  |  Author(s): S. Satram-Hoang
    • Abstract

    Background
    Non-small cell lung cancer (NSCLC) comprises 87% of all lung cancer in the United States with the vast majority diagnosed in advanced stage. Military personnel have higher smoking rates compared to the general population and consequently an increased incidence of lung cancer. We set out to examine whether there were variations in smoking rates and outcomes among patients diagnosed with NSCLC, based on self described ethnicity, in the United States Military and their dependents who receive equal and open access to healthcare in the Department of Defense (DOD) medical system.

    Methods
    We identified 4,547 patients ≥18 years, with an initial diagnosis of NSCLC from January 2003- March 2013 in the DOD Cancer Registry and categorized into the following self described ethnic groups: Caucasian, African American, Hispanic and Asian/Pacific Islander (PI). Differences in patient characteristics by race were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival.

    Results
    There were 3434 (76%) Caucasian, 533 (12%) African Americans, 468 (10%) Asian/PI, and 112 (2%) Hispanics who met the study inclusion criteria. Mean age at diagnosis was highest among Caucasians (67 yrs) followed by Asian/PI (64 yrs), Hispanics (63 yrs) and African Americans (62 yrs). A large majority of Caucasians (87%) and African Americans (86%) had a history of tobacco use, followed by Hispanics (74%) and Asian/PI (65%). Asian/PIs were also more likely to be female, married, have adenocarcinoma histology and were more likely to be sporadic cases (no family history) compared to the other self described ethnic groups. Asian/PIs had significantly higher unadjusted overall survival (Log rank p = 0.0012) and in the multivariate survival analysis, adjusting for age, sex, race, stage, histology, comorbidity, tobacco history, alcohol history, family history, and marital status, Asian/PI patients demonstrated a 20% lower risk of death (Table 1) compared to Caucasian patients. There was no difference in mortality risk between Caucasian and African Americans, and Caucasian and Hispanics.

    Conclusion
    In this military cohort, equal open access to care in NSCLC patients resulted in similar overall survival among Caucasian, African Americans and Hispanics with significantly higher OS among Asian/PIs. Racial disparities in survival often seen in US civilian populations were not seen in this study of patients treated in the military health system, perhaps due to more equal access to health care. Continued research evaluating treatment patterns and outcomes in the military relative to the general population is warranted.

    Table: Cox Proportional Hazards Regression of Overall Survival

    RACE	N	HR	95% CI
    Caucasian	3434	ref
    African American	533	1.001	0.89-1.12
    Asian/Pacific Islander	468	0.803	0.71-0.91
    Hispanic	112	0.984	0.77-1.26