Socioeconomic factors influence non-small cell lung cancer survival

Socioeconomic factors, such as lower education and median income, significantly influenced survival among patients with non-small cell lung cancer, according to study results presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.

Perspective from William K. Evans, MD, FRCP(C)

“The study is the largest analysis on the correlation between race and socioeconomic factors and NSCLC outcomes to date,” Yanyan Lou, MD, PhD, oncologist at Mayo Clinic in Jacksonville, Florida, said in a press release. “Our findings indicate that improving outcomes for patients with NSCLC doesn’t solely rely on advancements in medicine, but also on ensuring more equitable health care delivery.”

NSCLC survival has increased over the past few years, but it is unclear how socioeconomic factors affect these improvements.

Lou and colleagues used the National Cancer Data Base to identify 1.15 million incident NSCLC cases diagnosed between 2004 and 2013. Most patients were white (86.4%), 10.6% were black, and a minority were Asian or Hispanic.

Most patients had insurance (96.7%), lived in a metro area (81.7%) and received treatment at nonacademic facilities (68.5%). Researchers noted the population evenly represented income quartiles.

Median OS in the total population was 13.1 months. Researchers observed longer median OS among Asian patients (18.2 months) and Hispanic patients (16.6 months) than among white patients (13.2 months) and black patients (11.5 months; P < .001).

Factors associated with survival included comorbidity score, TNM stage, and treatment at community or high-volume facility (P < .001 or all).

Other than race, socioeconomic factors associated with improved survival included:

greater high school graduation rates (< 7% vs. 21% of population non-high school graduates, HR = 0.96; 95% CI, 0.94-0.97);
median local income higher than $38,000 ($63,000+, HR = 0.86; 95% CI, 0.85-0.87; $48,000-$62,999, HR = 0.93; 95% CI, 0.92-0.94; $38,000-$47,999, HR = 0.95; 95% CI, 0.94-0.96); and
being insured (HR = 0.79; 95% CI, 0.78-0.8).

Living in the central geographic region of the United States increased mortality risk compared with living in the Northeast (HR = 1.05; 95% CI, 1.04-1.06).

“We found Asian and Hispanic patients have better clinical outcomes than other races, and insurance status — particularly private insurance — income, education and location were found to influence NSCLC survival in this multivariable analysis with adjustments for multiple parameters,” Lou said during a press conference. “This study indicated that how care is delivered should be addressed to help improve clinical outcome for NSCLC.” – by Alexandra Todak

Reference:

Lou Y, et al. Abstract 9049. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Oct. 15-18, 2017; Yokohama, Japan.

Disclosures: Please see the abstract for a list of all authors’ relevant financial disclosures.

Perspective

William K. Evans, MD, FRCP(C)

I come from a country with universal health care access, but there are major equity issues nonetheless. So, we can deal with the funding issue for health care, but we still see disparity between socioeconomic status, immigrant status and, to some extent, gender. The difference between rural and urban is a little less marked in our situation; even though we are a big country with a small population, the population tends to be concentrated around where there are good health care facilities. In reviewing the cancer care in Ontario, I am quite struck by the variation in access along these metrics, even in a university health care system. We have a lot of work to do.

William K. Evans, MD, FRCP(C)

McMaster University

Disclosures: Evans reports no relevant financial disclosures.