Virtual Library
Start Your Search
C.P. Quesenberry Jr.
Author of
-
+
MINI 32 - Topics in Localized Lung Cancer (ID 166)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Boffa, T. D'Amico
- Coordinates: 9/09/2015, 18:30 - 20:00, 201+203
-
+
MINI32.13 - Racial/Ethnic and Gender Differences in Treatment and Survival of Early-Stage Non-Small Cell Lung Cancer in an Integrated Health Care System (ID 1083)
19:40 - 19:45 | Author(s): C.P. Quesenberry Jr.
- Abstract
Background:
In the U.S., racial/ethnic and gender differences in treatment and survival of early stage non-small cell lung cancer (NSCLC) have been reported. These findings come largely from analyses of SEER-Medicare data, which inherently exclude younger and managed care patients, up through 2005. Whether such differences exist in an integrated health care system, other than the U.S. Military Health System and Veterans Health Administration, has not been comprehensively examined.
Methods:
Using electronic health record and cancer registry data from Kaiser Permanente Northern California, a fully integrated health care system, we identified a cohort of 1,566 patients of non-Hispanic White, Asian/Pacific Islander, Black, or Hispanic race/ethnicity diagnosed with incident stage I/II NSCLC at ages 21 to 80 years from 2004 to 2011. Patients were followed from NSCLC diagnosis to health plan termination, death, or study end (through 2013), whichever occurred earliest. We examined whether the following prognostic factors (at NSCLC diagnosis, unless otherwise specified), in addition to 3-year overall survival, differed statistically (p<0.05) by race/ethnicity or gender: age; marital status; smoking history; comorbidity score; tumor stage, size, and histology; and receipt, modality, and timing of initial treatment. Using multivariable Cox regression, we further examined the extent to which race/ethnicity and gender were associated with overall survival after accounting for other prognostic factors.
Results:
Our cohort included 1137 non-Hispanic Whites (482 men, 655 women); 232 Asian/Pacific Islanders (95 men, 127 women); 126 Blacks (52 men, 74 women); and 71 Hispanics (36 men, 35 women). The median age at diagnosis was 68 years. Overall, 92% were treated (89% of those treated by surgery), within 1.8 months post-diagnosis on average, and 41% died during 69,894 person-years of follow-up (median=3.3 years). Comparing across the race/ethnicity groups, non-Hispanic Whites were generally older at diagnosis, while Asian/Pacific Islanders were more likely to be married, never or former smokers, have a lower comorbidity score, and diagnosed with adenocarcinoma. The group most commonly treated with surgery was Asians/Pacific Islanders (87.5%), followed by Hispanics (81.7%), non-Hispanic Whites (79.9%), and Blacks (65.1%), with 3-year overall survival probabilities of 77%, 73%, 69%, and 63%, respectively. Compared to women, men were more likely to be married, former or current smokers, have a higher comorbidity score, and have a tumor of higher stage, greater size, and squamous cell histology, although both their receipt of surgery (women: 82%, men: 78%) and 3-year overall survival probabilities (women: 71%, men: 69%) were similar. After accounting for age, marital status, smoking history, comorbidity score, tumor characteristics, and receipt, modality, and timing of initial treatment, overall survival was similar for Asian/Pacific Islanders (hazard ratio (HR): 0.90; 95% confidence interval (CI): 0.69-1.17), Hispanics (HR: 0.96; 95% CI: 0.66-1.42), and Blacks (HR: 0.99; 95% CI: 0.75-1.31) compared to non-Hispanic Whites, and for men (HR: 0.95; 95% CI: 0.80-1.13) compared to women.
Conclusion:
Among early stage NSCLC patients in our integrated health care system, we found racial/ethnic differences in treatment, but no racial/ethnic or gender differences in overall survival after accounting for treatment and other prognostic factors.
