The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer

John M. Varlotto, Kerri McKie, Rickie P. Voland, John C. Flickinger, Malcom McAvoy DeCamp Jr, Debra Maddox, Paul Stephen Rava, Thomas J. Fitzgerald, William Walsh, Paulo Oliveira, Negar Rassaei, Jennifer Baima, Karl Uy

Research output: Contribution to journalArticle

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Abstract

Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

Original languageEnglish (US)
Article number146
JournalFrontiers in Oncology
Volume8
Issue numberMAY
DOIs
StatePublished - May 14 2018

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Non-Small Cell Lung Carcinoma
Economics
Survival
Lung Neoplasms
Insurance
Hispanic Americans
Ethnic Groups
Widowhood
Divorce
Population
Medicaid
Ear Neoplasms
Insurance Coverage
Marriage
Ear
Epidemiology
Adenocarcinoma
Databases
Mortality

Keywords

  • Lung cancer
  • Marital status
  • Racial differences
  • Socioeconomic status
  • Surgical resection

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Varlotto, John M. ; McKie, Kerri ; Voland, Rickie P. ; Flickinger, John C. ; DeCamp Jr, Malcom McAvoy ; Maddox, Debra ; Rava, Paul Stephen ; Fitzgerald, Thomas J. ; Walsh, William ; Oliveira, Paulo ; Rassaei, Negar ; Baima, Jennifer ; Uy, Karl. / The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer. In: Frontiers in Oncology. 2018 ; Vol. 8, No. MAY.
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abstract = "Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.",
keywords = "Lung cancer, Marital status, Racial differences, Socioeconomic status, Surgical resection",
author = "Varlotto, {John M.} and Kerri McKie and Voland, {Rickie P.} and Flickinger, {John C.} and {DeCamp Jr}, {Malcom McAvoy} and Debra Maddox and Rava, {Paul Stephen} and Fitzgerald, {Thomas J.} and William Walsh and Paulo Oliveira and Negar Rassaei and Jennifer Baima and Karl Uy",
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Varlotto, JM, McKie, K, Voland, RP, Flickinger, JC, DeCamp Jr, MM, Maddox, D, Rava, PS, Fitzgerald, TJ, Walsh, W, Oliveira, P, Rassaei, N, Baima, J & Uy, K 2018, 'The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer' Frontiers in Oncology, vol. 8, no. MAY, 146. https://doi.org/10.3389/fonc.2018.00146

The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer. / Varlotto, John M.; McKie, Kerri; Voland, Rickie P.; Flickinger, John C.; DeCamp Jr, Malcom McAvoy; Maddox, Debra; Rava, Paul Stephen; Fitzgerald, Thomas J.; Walsh, William; Oliveira, Paulo; Rassaei, Negar; Baima, Jennifer; Uy, Karl.

In: Frontiers in Oncology, Vol. 8, No. MAY, 146, 14.05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role of race and economic characteristics in the presentation and survival of patients with surgically resected non-small cell lung cancer

AU - Varlotto, John M.

AU - McKie, Kerri

AU - Voland, Rickie P.

AU - Flickinger, John C.

AU - DeCamp Jr, Malcom McAvoy

AU - Maddox, Debra

AU - Rava, Paul Stephen

AU - Fitzgerald, Thomas J.

AU - Walsh, William

AU - Oliveira, Paulo

AU - Rassaei, Negar

AU - Baima, Jennifer

AU - Uy, Karl

PY - 2018/5/14

Y1 - 2018/5/14

N2 - Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

AB - Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors. Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR. Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity. Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

KW - Lung cancer

KW - Marital status

KW - Racial differences

KW - Socioeconomic status

KW - Surgical resection

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