Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease

John Michael Varlotto, Richard Voland, Kerrie McKie, John C. Flickinger, Malcom McAvoy DeCamp Jr, Debra Maddox, Paul Rava, Thomas J. Fitzgerald, Geoffrey Graeber, Negar Rassaei, Paulo Oliveira, Suhail Ali, Chandra Belani, Jonathan Glanzman, Heather A. Wakelee, Manali Patel, Jennifer Baima, Jianying Zhang, William Walsh

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007–2012. Population differences were assessed via chi-square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer-specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.

Original languageEnglish (US)
Pages (from-to)1211-1220
Number of pages10
JournalCancer medicine
Volume7
Issue number4
DOIs
StatePublished - Apr 1 2018

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Lung Neoplasms
Economics
Lung
Survival
Insurance
Population
Widowhood
Hispanic Americans
Ethnic Groups
Marital Status
Marriage
Early Detection of Cancer
Squamous Cell Carcinoma
Adenocarcinoma
Databases

Keywords

  • Disparities
  • insurance
  • lung cancer
  • marriage
  • metastatic lung cancer
  • outcomes
  • race
  • socio-economic factors

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Varlotto, John Michael ; Voland, Richard ; McKie, Kerrie ; Flickinger, John C. ; DeCamp Jr, Malcom McAvoy ; Maddox, Debra ; Rava, Paul ; Fitzgerald, Thomas J. ; Graeber, Geoffrey ; Rassaei, Negar ; Oliveira, Paulo ; Ali, Suhail ; Belani, Chandra ; Glanzman, Jonathan ; Wakelee, Heather A. ; Patel, Manali ; Baima, Jennifer ; Zhang, Jianying ; Walsh, William. / Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease. In: Cancer medicine. 2018 ; Vol. 7, No. 4. pp. 1211-1220.
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abstract = "To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007–2012. Population differences were assessed via chi-square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer-specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.",
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Varlotto, JM, Voland, R, McKie, K, Flickinger, JC, DeCamp Jr, MM, Maddox, D, Rava, P, Fitzgerald, TJ, Graeber, G, Rassaei, N, Oliveira, P, Ali, S, Belani, C, Glanzman, J, Wakelee, HA, Patel, M, Baima, J, Zhang, J & Walsh, W 2018, 'Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease', Cancer medicine, vol. 7, no. 4, pp. 1211-1220. https://doi.org/10.1002/cam4.1430

Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease. / Varlotto, John Michael; Voland, Richard; McKie, Kerrie; Flickinger, John C.; DeCamp Jr, Malcom McAvoy; Maddox, Debra; Rava, Paul; Fitzgerald, Thomas J.; Graeber, Geoffrey; Rassaei, Negar; Oliveira, Paulo; Ali, Suhail; Belani, Chandra; Glanzman, Jonathan; Wakelee, Heather A.; Patel, Manali; Baima, Jennifer; Zhang, Jianying; Walsh, William.

In: Cancer medicine, Vol. 7, No. 4, 01.04.2018, p. 1211-1220.

Research output: Contribution to journalArticle

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T1 - Population-based differences in the outcome and presentation of lung cancer patients based upon racial, histologic, and economic factors in all lung patients and those with metastatic disease

AU - Varlotto, John Michael

AU - Voland, Richard

AU - McKie, Kerrie

AU - Flickinger, John C.

AU - DeCamp Jr, Malcom McAvoy

AU - Maddox, Debra

AU - Rava, Paul

AU - Fitzgerald, Thomas J.

AU - Graeber, Geoffrey

AU - Rassaei, Negar

AU - Oliveira, Paulo

AU - Ali, Suhail

AU - Belani, Chandra

AU - Glanzman, Jonathan

AU - Wakelee, Heather A.

AU - Patel, Manali

AU - Baima, Jennifer

AU - Zhang, Jianying

AU - Walsh, William

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N2 - To investigate the interrelation between economic, marital, and known histopathologic/therapeutic prognostic factors in presentation and survival of patients with lung cancer in nine different ethnic groups. A retrospective review of the SEER database was conducted through the years 2007–2012. Population differences were assessed via chi-square testing. Multivariable analyses (MVA) were used to detect overall survival (OS) differences in the total population (TP, N = 153,027) and for those patients presenting with Stage IV (N = 70,968). Compared to Whites, Blacks were more likely to present with younger age, male sex, lower income, no insurance, single/widowed partnership, less squamous cell carcinomas, and advanced stage; and experience less definitive surgery, lower OS, and lung cancer-specific (LCSS) survival. White Hispanics presented with younger age, higher income, lower rates of insurance, single/widowed partnership status, advanced stage, more adenocarcinomas, and lower rates of definitive surgery, but no difference in OS and LCSS than Whites. In the TP and Stage IV populations, MVAs revealed that OS was better or equivalent to Whites for all other ethnic groups and was positively associated with insurance, marriage, and higher income. Blacks presented with more advanced disease and were more likely to succumb to lung cancer, but when adjusted for prognostic factors, they had a better OS in the TP compared to Whites. Disparities in income, marital status, and insurance rather than race affect OS of patients with lung cancer. Because of their presentation with advanced disease, Black and Hispanics are likely to have increased benefit from lung cancer screening.

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KW - Disparities

KW - insurance

KW - lung cancer

KW - marriage

KW - metastatic lung cancer

KW - outcomes

KW - race

KW - socio-economic factors

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