Health Services Research

PV 03 - Poster Viewing Q&A - Session 3

TU_6_3014 - Disparate Outcomes in Non-Small Cell Lung Cancer By Race and Immigrant Status

Tuesday, September 17
1:00 PM - 2:15 PM
Location: ASTRO Innovation Hub

Disparate Outcomes in Non-Small Cell Lung Cancer By Race and Immigrant Status
A. Amini1, A. Shinde1, R. Li1, P. Ituarte2, J. Vazquez1, S. M. Glaser1, E. Massarelli3, L. Erhunmwunsee2, R. Salgia3, and K. Ashing4; 1Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 2Department of Surgery, City of Hope National Medical Center, Duarte, CA, 3Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, 4Department of Population Sciences, City of Hope National Medical Center, Duarte, CA

Purpose/Objective(s): Prior studies demonstrated the impact of race on overall survival (OS) for non-small cell lung cancer (NSCLC). However, there is limited data evaluating the effects of both race and nation of origin on OS. The purpose of this study was to evaluate OS outcomes by race, stratified by country of origin in patients diagnosed with NSCLC.

Materials/Methods: We performed a retrospective analysis of NSCLC patients diagnosed between 2000 and 2012 recorded in the California Cancer Registry. Race/ethnicity was defined as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (H), and Asian (A) and further stratified by country of origin (US vs. non-US [NUS]) creating the following patient cohorts: NHW-US, NHW-NUS, NHB-US, NHB-NUS, H-US, H-NUS, A-US, A-NUS. Kaplan-Meier analysis was performed for univariate survival. Cox proportional hazards models estimated hazard of mortality by race and immigration status adjusting for age, sex, marital status, neighborhood socioeconomic status (nSES), health insurance, year of diagnosis, overall stage and histology. A separate model included all previous factors andtreatment received (surgery, radiation, chemotherapy). Multivariate logistic regression was performed to predict differences in treatment.

Results: A total of 140,366 patients with NSCLC were included. Median OS presented from highest to lowest are: A-NUS (33.4 mo), A-US (33.1 mo), NHW-NUS (31.2 mo), NHW-US (30.2 mo), H-NUS (29.6 mo), H-US (28.0 mo), NHB-US (26.5 mo), NHB-NUS (24.4 mo) (log rank p<0.001). On multivariate analysis including patient and disease characteristics only, NHB-US, A-US, A-NUS, and H-NUS had longer OS when compared to NHW-US (hazard ratios [HRs] 0.85-0.96, p ≤ 0.006 for all). NHW-NUS (HR 1.02, p=0.010) and NHB-NUS (HR 1.05, p=0.004) had worse OS, with no significant difference seen for H-US (HR 0.97, p=0.174). When accounting for treatment received, NHB-US, A-US, NHW-NUS (HR 0.97, p<0.001), H-NUS, and A-NUS had improved OS compared to NHW-US (HRs 0.79-0.93, p≤0.004 for all). There was no significant difference in OS for H-US (0.97, p=0.062) and NHB-NUS (HR 0.97, p=0.056). When compared to NHB-US, NHB-NUS were less likely to undergo treatment including chemotherapy (odds ratio [OR] 0.75, p<0.001) and surgery (OR 0.78, p<0.001); no difference was seen with radiation.

Conclusion: This novel study showed that disparities in both OS and treatment are influenced by both race and immigrant status. Foreign born persons of African Ancestry/Blacks with NSCLC appear to have the highest risk of mortality when not accounting for receipt of treatment. When treatment is accounted for, there appears to be no significant difference in survival between Blacks and NHWs. In comparison to US born African-Americans, foreign born persons of African ancestry appear to less commonly undergo treatment including surgery or chemotherapy.

Author Disclosure: A. Amini: None. A. Shinde: None. R. Li: None. P. Ituarte: None. S.M. Glaser: None. E. Massarelli: None. L. Erhunmwunsee: None.

Arya Amini, MD

City of Hope National Medical Center

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